Mechanical Ventilation

20Nov 2018

Bélaïd Bouhemad, Ophélie Dransart-Rayé, Francesco Mojoli, Silvia Mongodi   Ann Transl Med 2018;6(21):418   Abstract: Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in intensive care units (ICU) and is associated with increased mortality, use of antimicrobials, longer mechanical ventilation, and higher healthcare costs. Lung ultrasonography (LUS) can be used at the bedside and […]

20Nov 2018

Francesco Mojoli, Francesca Torriglia, Anita Orlando, Isabella Bianchi, Eric Arisi, Marco Pozzi Ann Transl Med 2018;6(19):377 Abstract: Transpulmonary pressure, that is the difference between airway pressure (Paw) and pleural pressure, is considered one of the most important parameters to know in order to set a safe mechanical ventilation in acute respiratory distress syndrome (ARDS) patients […]

30Oct 2018

Mojoli F, Bouhemad B, Mongodi S, Lichtenstein D.   Am J Respir Crit Care Med. 2018 Oct 29. doi: 10.1164/rccm.201802-0236CI.   Abstract Point-of-care ultrasound is increasingly used at the bedside to integrate the clinical assessment of the critically ill; in particular, lungultrasound greatly developed in the last decade. This review describes basic lung ultrasound signs and focuses on their applications in critical […]

14Aug 2018

By A. Orlando – White paper Background Asynchronies are a frequent issue in ventilated patients. They represent a mismatch between the inspiratory and expiratory times of patient and ventilator, and thus a failure to provide ventilated patients with optimal assistance. This results in prolonged mechanical ventilation, difficult wean-ing, reduced patient comfort, an increased risk of diaphragmatic […]

01Aug 2018

Chiumello D, Mongodi S, Algieri I, Vergani GL, Orlando A, Via G, Crimella F, Cressoni M, Mojoli F. Crit Care Med. 2018 Jul 25. doi: 10.1097/CCM.0000000000003340 Abstract OBJECTIVES: Lung ultrasound is commonly used to evaluate lung morphology in patients with acute respiratory distress syndrome. Aim of this study was to determine lung ultrasound reliability in […]

17Mar 2018

Lluís Blanch, Jean-Michel Arnal, Francesco Mojoli ICU Management & Practice, Volume 18 – Issue 1, 2018   Dr. Lluís Blanch, Dr. Jean-Michel Arnal and Prof. Francesco Mojoli discuss why patient-ventilator synchrony is important, how to detect asynchronies, and technical solutions for optimising synchronisation. Report on the Hamilton Medical symposium, LIVES 2017, Vienna, Austria, 26 September […]

17Sep 2017

F. Mojoli, S. Mongodi ICU Management & Practice. 2017;17(3):186-9. In the last years, ultrasound (US) became an essential tool in the hands of the intensivist and is now recommended both for procedural guidance and diagnostic purposes. Point-of-care ultrasound (POCUS) is an immediately available and repeatable, non-irradiating bedside tool integrating the clinical examination.   While echocardiography […]

23Aug 2017

Spadaro S, Karbing DS, Fogagnolo A, Ragazzi R, Mojoli F, Astolfi L, Gioia A, Marangoni E, Rees SE, Carlo VA.   Simul Healthc. 2017 Aug 18. doi: 10.1097/SIH.0000000000000249   Abstract INTRODUCTION: Advances in knowledge regarding mechanical ventilation (MV), in particular lung-protective ventilation strategies, have been shown to reduce mortality. However, the translation of these advances […]

03May 2017

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S. Mongodi, F. Mojoli, G. Via, G. Tavazzi, F. Fava, M. Pozzi, G. A. Iotti, B. Bouhemad

Introduction: Weaning failure (WF) from mechanical ventilation (MV) may be due to lung derecruitment, cardiac dysfunction and respiratory muscles weakness. Transthoracic echocardiography (TTE) [1], lung ultrasound (LUS) [2] and diaphragm ultrasound (DUS) [3] have shown their value in early identification of the failing patients separately. A combination of TTE, LUS and DUS could improve the identification of failing patients and of WF etiology [4]. We aimed to estimate the value of a combined ultrasound assessment (heart-lung-diaphragm) to early identify patients at high risk of WF from MV.

Methods: Prospective observational multicenter international study including all patients undergoing a 30’ spontaneous breathing trial (SBT) before extubation. Patients with neuromuscular diseases and MV <48 hours were excluded. TTE and LUS were performed before SBT and at its end; DUS at beginning and end of SBT. TTE included: MAPSE (mitral annulus plane systolic excursion), EF% (ejection fraction), E/A, E/Ea. We computed LUS score (0–36) [2]. DUS assessed diaphragm excursion. Extubation was considered as failed in case of reintubation, non-invasive ventilation or death within 48 hours. We used classical criteria for SBT failure. Extubation was decided by an independent operator.

Results: We enrolled 18 patients (age 77.7 ± 11.4 yrs, BMI 29.9 ± 7, SAPSII 54.4 ± 17.4, MV length 9.5 ± 7.3 days). 6 patients (33%) failed the SBT and were not extubated. 12 patients (67%) were extubated; 5 failed. Two populations were identified: WF (failed SBT or extubation) and weaning success (WS). LUS: SBT-LUS was higher than MVLUS in the whole population (17 ± 4 vs. 12 ± 3; p = 0.019); this was more remarkable in WF (20 ± 3 vs. 11 ± 3; p = 0.0004). SBT-LUS was higher in WF vs. WS (20 ± 3 vs. 13 ± 4; p = 0.03). SBT-LUS predicted SBT and weaning failure (respectively AUC 0,877 and AUC 0,883). TTE: E/A and E/Ea (both MW and SBT) did not predict WF, extubation failure nor SBT-failure. MV-MAPSE predicted WF (AUC 0,833); if < =10 mm it predicted WF with sensitivity 0.67 and specificity 1. SBTMAPSE predicted extubation failure (AUC 0.833). DUS: No correlation between diaphragm excursion and WF was identified.

Conclusions: LUS and MAPSE seem to be the most useful parameters to predict weaning failure.

References 1. Caille et al., Crit Care 2010 2. Soummer et al., Crit Care Med 2012 3. Kim et al., CCM 2011 4. Mongodi et al., Crit Care Med 2013

Grant The research project received the ESICM Clinical Research Award 2015.

Pag. 30 From Critical Care

12Oct 2016

Bianzina S, Cornara P, Rodi G, Tavazzi G, Iotti GA, Mojoli F, Braschi A   Intensive Care Medicine Experimental 2016, 4(Suppl 1):27;116   Introduction: Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by a perturbation in surfactant homeostasis, resulting in its accumulation within alveolar spaces, with a consequent development of severe hypoxemia. Whole lung lavage (WLL) is a complex […]