Showing papers by "Paolo Pelosi published in 1995"
TL;DR: Whether increasing the cardiac index to a supranormal level (cardiac-index group) or increasing mixed venous oxygen saturation to a normal level (oxygen-saturation group) would decrease morbidity and mortality among critically ill patients, as compared with a control group in which the target was a normal cardiac index.
Abstract: Background Hemodynamic therapy to raise the cardiac index and oxygen delivery to supranormal levels may improve outcomes in critically ill patients. We studied whether increasing the cardiac index to a supranormal level (cardiac-index group) or increasing mixed venous oxygen saturation to a normal level (oxygen-saturation group) would decrease morbidity and mortality among critically ill patients, as compared with a control group in which the target was a normal cardiac index. Methods A total of 10,726 patients in 56 intensive care units were screened, among whom 762 patients belonging to predefined diagnostic categories with acute physiology scores of 11 or higher were randomly assigned to the three groups (252 to the control group, 253 to the cardiac-index group, and 257 to the oxygen-saturation group). Results The hemodynamic targets were reached by 94.3 percent of the control group, 44.9 percent of the cardiac-index group, and 66.7 percent of the oxygen-saturation group (P<0.001). Mortality was 48.4, ...
1,365 citations
TL;DR: The distribution of tidal volume (VT) and recruitment was investigated by chest computed tomography (CT) in eight sedated-paralyzed patients with the adult respiratory distress syndrome (ARDS) and found that with increasing PEEP, the VTct distribution decreased significantly in the upper levels, did not change in the middle levels, and increased significantly (p < 0.01) in the lower levels.
Abstract: The distribution of tidal volume (VT) and recruitment was investigated by chest computed tomography (CT) in eight sedated-paralyzed patients with the adult respiratory distress syndrome (ARDS). A CT section was obtained in the supine position at 0, 5, 10, 15, and 20 cm H2O positive end-expiratory pressure (PEEP) and at the corresponding inspiratory plateau pressure (21 +/- 1.8, 26 +/- 1.4, 31 +/- 1.8, 38 +/- 2.1, and 46 +/- 3.2 cm H2O [mean +/- SE]), keeping VT constant. Each CT section was divided along its ventral-dorsal height into 10 equally spaced intervals (levels). Vi(insp) and Vi(exp) were defined as the gas volume for level i (i = 1 to 10) at end-inspiration and at end-expiration, respectively. The following variables were computed at each lung level: (1) distribution of CT section tidal volume (VTct), i.e., the fraction of VT that inflates a given lung level; (2) the plateau-induced and PEEP-induced recruitment, i.e., the amount of lung tissue previously collapsed that inflates at plateau pressu...
524 citations
TL;DR: In 16 mechanically ventilated patients with acute lung injury (ALI) and in eight normal anesthetized-paralyzed subjects (control group), the total respiratory system mechanics were partitioned into the lung (L) and chest wall (w) mechanics using the esophageal balloon technique together with the airway occlusion technique during constant flow inflation.
Abstract: In 16 mechanically ventilated patients with acute lung injury (ALI) (eight patients with moderate ALI [moderate group], eight patients with severe ALI [adult respiratory distress syndrome, ARDS group]) and in eight normal anesthetized-paralyzed subjects (control group), we partitioned the total respiratory system mechanics into the lung (L) and chest wall (w) mechanics using the esophageal balloon technique together with the airway occlusion technique during constant flow inflation. We measured lung elastance (Est,L), chest wall elastance (Est,w), and total lung (Rmax, L) and chest wall (Rmax,w) resistance. Rmax,L includes airway (Rmin,L) and "additional" lung resistance (DR,L). DR,L represents the "additional" component due to the viscoelastic phenomena of the lung tissues and time-constant inequalities (pendelluft). Measurements were repeated at 0, 5, and 10 cm H2O of positive end-expiratory pressure (PEEP) in the control group and at 0, 5, 10, and 15 cm H2O PEEP in patients with ALI. The end-expiratory...
206 citations
TL;DR: The prone position during general anesthesia does not negatively affect respiratory mechanics and improves lung volumes and oxygenation and the functional residual capacity (FRC) and gas exchange is found.
Abstract: We investigated the effects of the prone position on the mechanical properties (compliance and resistance) of the total respiratory system, the lung, and the chest wall, and the functional residual capacity (FRC) and gas exchange in 17 normal, anesthetized, and paralyzed patients undergoing elective surgery. We used the esophageal balloon technique together with rapid airway occlusions during constant inspiratory flow to partition the mechanics of the respiratory system into its pulmonary and chest wall components. FRC was measured by the helium dilution technique. Measurements were taken in the supine position and after 20 min in the prone position maintaining the same respiratory pattern (tidal volume 10 mL/kg, respiratory rate 14 breaths/min, FIO2 0.4). We found that the prone position did not significantly affect the respiratory system compliance (80.9 +/- 16.6 vs 75.9 +/- 13.2 mL/cm H2O) or the lung and chest wall compliance. Respiratory resistance slightly increased in the prone position (4.8 +/- 2.5 vs 5.4 +/- 2.7 cm H2O.L-1.s,P < 0.05), mainly due to the chest wall resistance (1.3 +/- 0.6 vs 1.9 +/- 0.8 cm H2O.L-1.s, P < 0.05). Both FRC and PaO2 markedly (P < 0.01) increased from the supine to the prone position (1.9 +/- 0.6 vs 2.9 +/- 0.7 L, P < 0.01, and 160 +/- 37 vs 199 +/- 16 mm Hg, P < 0.01, respectively), whereas PaCO2 was unchanged. In conclusion, the prone position during general anesthesia does not negatively affect respiratory mechanics and improves lung volumes and oxygenation.
182 citations
TL;DR: In the pig, purified homodimeric proteins with subunits of 17 kDa are obtained, both from von Ebner's glands and from lachrymal glands, and appear to be identical, as in humans.
Abstract: Small soluble proteins, belonging to the lipocalin family are secreted in large amounts by tongue von Ebner's glands and lachrymal glands. In humans, the lingual protein, called VEG, and the lachrymal protein, called tear prealbumin, have shown identical cDNA sequences. In the pig, we have purified homodimeric proteins with subunits of 17 kDa, both from von Ebner's glands and from lachrymal glands. In both cases, the proteins can be resolved into two isoforms on a chromatofocusing column. Partial aminoacid sequences and full cDNA sequences have been obtained for the more abundant forms purified from both tissues. The two proteins appear to be identical, as in humans. The reason why the same protein is expressed in different tissues, as well as its physiological function, still remain to be clarified
35 citations
01 Jan 1995
TL;DR: The concept of increasing oxygen delivery (DO2) has been applied in various diseases and syndromes, including sepsis, in order to correct impaired oxygen transport to tissues, possible mismatch between regional blood flow and regional oxygen demand, or altered tissue capability for oxygen extraction.
Abstract: The concept of increasing oxygen delivery (DO2) has been applied in various diseases and syndromes, including sepsis, in order to correct impaired oxygen transport to tissues, possible mismatch between regional blood flow and regional oxygen demand, or altered tissue capability for oxygen extraction.
3 citations