0000000000333371

AUTHOR

Paolo Severgnini

showing 12 related works from this author

Individualized versus fixed positive end-expiratory pressure for intraoperative mechanical ventilation in obese patients: a secondary analysis

2021

Background General anesthesia may cause atelectasis and deterioration in oxygenation in obese patients. The authors hypothesized that individualized positive end-expiratory pressure (PEEP) improves intraoperative oxygenation and ventilation distribution compared to fixed PEEP. Methods This secondary analysis included all obese patients recruited at University Hospital of Leipzig from the multicenter Protective Intraoperative Ventilation with Higher versus Lower Levels of Positive End-Expiratory Pressure in Obese Patients (PROBESE) trial (n = 42) and likewise all obese patients from a local single-center trial (n = 54). Inclusion criteria for both trials were elective laparoscopic abdominal…

Pulmonary Atelectasismedicine.medical_treatment[SDV]Life Sciences [q-bio]AtelectasisPositive-Pressure Respiration03 medical and health sciences0302 clinical medicine030202 anesthesiologyInterquartile rangemedicineTidal VolumeHumansObesity10. No inequalityPEEPPositive end-expiratory pressureTidal volumeComputingMilieux_MISCELLANEOUS2. Zero hungerMechanical ventilationbusiness.industryRespirationEnvironmental air flowOxygenationrespiratory systemmedicine.disease3. Good healthrespiratory tract diseasesAnesthesiology and Pain MedicineAnesthesiaArtificialBreathingbusinesstherapeutics030217 neurology & neurosurgeryHumans; Obesity; Positive-Pressure Respiration; Pulmonary Atelectasis; Respiration Artificial; Tidal Volumecirculatory and respiratory physiology
researchProduct

Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical…

2022

BACKGROUND: High intraoperative PEEP with recruitment manoeuvres may improve perioperative outcomes. We re-examined this question by conducting a patient-level meta-analysis of three clinical trials in adult patients at increased risk for postoperative pulmonary complications who underwent non-cardiothoracic and non-neurological surgery. METHODS: The three trials enrolled patients at 128 hospitals in 24 countries from February 2011 to February 2018. All patients received volume-controlled ventilation with low tidal volume. Analyses were performed using one-stage, two-level, mixed modelling (site as a random effect; trial as a fixed effect). The primary outcome was a composite of postoperati…

AdultLung Diseases*PEEP*postoperative pulmonary complicationsmechanical ventilationPositive-Pressure RespirationsurgeryAnesthesiology and Pain MedicinePostoperative ComplicationsTidal Volume*surgeryHumanspostoperative pulmonary complicationsPostoperative Period*mechanical ventilationmechanical ventilation; PEEP; postoperative pulmonary complications; surgery; Adult; Humans; Lung; Postoperative Complications; Postoperative Period; Randomized Controlled Trials as Topic; Tidal Volume; Lung Diseases; Positive-Pressure RespirationLungPEEPRandomized Controlled Trials as Topic
researchProduct

Correction to: Protective ventilation with high versus low positive end-expiratory pressure during one-lung ventilation for thoracic surgery (PROTHOR…

2019

Background Postoperative pulmonary complications (PPC) may result in longer duration of in-hospital stay and even mortality. Both thoracic surgery and intraoperative mechanical ventilation settings add considerably to the risk of PPC. It is unclear if one-lung ventilation (OLV) for thoracic surgery with a strategy of intraoperative high positive end-expiratory pressure (PEEP) and recruitment maneuvers (RM) reduces PPC, compared to low PEEP without RM. Methods PROTHOR is an international, multicenter, randomized, controlled, assessor-blinded, two-arm trial initiated by investigators of the PROtective VEntilation NETwork. In total, 2378 patients will be randomly assigned to one of two differe…

medicine.medical_specialtyone-lung ventilationMedicine (miscellaneous)recruitment maneuverVentilaciólaw.invention03 medical and health sciencesStudy Protocol0302 clinical medicineMechanical ventilationRandomized controlled triallawmedicinePharmacology (medical)030212 general & internal medicinePositive end-expiratory pressureTòrax2. Zero hungerProtocol (science)lcsh:R5-920Cirurgiabusiness.industryrespiratory systemOne lung ventilationthoracic surgery3. Good healthrespiratory tract diseasesProtective ventilationCardiothoracic surgeryAnesthesiapostoperative pulmonary complicationlcsh:Medicine (General)business030217 neurology & neurosurgerypositive end-expiratory pressure
researchProduct

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

2021

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (V(T)). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients. OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference. DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries. MAIN OUTCOME MEASURES: Women and men were compared with respect to use o…

AdultMalemedicine.medical_specialtyIntra operativehealth care facilities manpower and services[SDV]Life Sciences [q-bio]Critical IllnessLas Vegas StudyArticle03 medical and health sciences0302 clinical medicine030202 anesthesiologyInternal medicineTidal VolumemedicineHumansGeneral anaesthesiaLungTidal volumeAdult; Critical Illness; Female; Humans; Lung; Male; Tidal Volume; Respiration Artificial; Sex CharacteristicsSex CharacteristicsLas vegasbusiness.industryRespirationrespiratory failure sexrespiratory systemSex differenceRespiration Artificialrespiratory tract diseasesAnesthesiology and Pain Medicine030228 respiratory systemRelative riskArtificialCohortBreathingFemaleObservational studybusinessintra-operative tidal volumecirculatory and respiratory physiology
researchProduct

Protective Mechanical Ventilation during General Anesthesia for Open Abdominal Surgery Improves Postoperative Pulmonary Function

2013

Abstract Background: The impact of intraoperative ventilation on postoperative pulmonary complications is not defined. The authors aimed at determining the effectiveness of protective mechanical ventilation during open abdominal surgery on a modified Clinical Pulmonary Infection Score as primary outcome and postoperative pulmonary function. Methods: Prospective randomized, open-label, clinical trial performed in 56 patients scheduled to undergo elective open abdominal surgery lasting more than 2 h. Patients were assigned by envelopes to mechanical ventilation with tidal volume of 9 ml/kg ideal body weight and zero-positive end-expiratory pressure (standard ventilation strategy) or tidal vol…

Malemedicine.medical_specialtymedicine.medical_treatmentAnesthesia GeneralLung DiseaseFollow-Up StudiePulmonary function testingPositive-Pressure RespirationProtective Mechanical VentilationAbdomenTidal VolumeMedicineRespiratory functionPostoperative PeriodTidal volumePositive end-expiratory pressureAgedRespiratory Function TestMechanical ventilationIntraoperative CareLungbusiness.industryOxygenationRespiration ArtificialSurgeryClinical trialProspective StudieTreatment OutcomeAnesthesiology and Pain Medicinemedicine.anatomical_structureAnesthesiaBreathingFemalePostoperative ComplicationbusinessHumanAbdominal surgery
researchProduct

Epidemiological characteristics, practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensiv…

2016

Background Scant information exists about the epidemiological characteristics and outcome of patients in the intensive care unit (ICU) at risk of acute respiratory distress syndrome (ARDS) and how ventilation is managed in these individuals. We aimed to establish the epidemiological characteristics of patients at risk of ARDS, describe ventilation management in this population, and assess outcomes compared with people at no risk of ARDS. Methods PRoVENT (PRactice of VENTilation in critically ill patients without ARDS at onset of ventilation) is an international, multicentre, prospective study undertaken at 119 ICUs in 16 countries worldwide. All patients aged 18 years or older who were rece…

MalePediatricsARDSmedicine.medical_treatmentlaw.inventionPositive-Pressure Respiration0302 clinical medicinelawRisk FactorsPrevalenceventilator–induced lung injuryProspective StudiesHospital MortalityProspective cohort studyTidal volumeeducation.field_of_studyRespiratory Distress SyndromeAcute respiratory distress syndrometidal volumeARDS critically ill ventilationMiddle AgedIntensive care unitIntensive Care UnitsCritical IllneFemaleHumanPulmonary and Respiratory Medicinemedicine.medical_specialtyCritical IllnessPopulationIntensive Care UnitLung injurymechanical ventilationNO03 medical and health sciencesIntensive caremedicineAcute respiratory distress syndrome mechanical ventilation ventilator–induced lung injury tidal volume positive end–expiratory pressureHumansMED/41 - ANESTESIOLOGIAeducationAgedMechanical ventilationbusiness.industryRisk FactorRespiratory Distress Syndrome Adult030208 emergency & critical care medicinemedicine.diseaseRespiration ArtificialMechanical ventilation Acute respiratory failure Acute respiratory distress syndromeProspective Studie030228 respiratory systemEmergency medicinepositive end–expiratory pressurebusiness
researchProduct

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute resp…

2022

Contains fulltext : 252214.pdf (Publisher’s version ) (Open Access) BACKGROUND: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. METHODS: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to defi…

MaleSociodemographic FactorsRespiration Artificial/methodsARDS ; mechanical ventilationSeverity of Illness IndexNOSettore MED/41 - ANESTESIOLOGIA80 and overTidal VolumeHumansHospital MortalityProspective Studiesddc:610Developing CountriesAgedHospital Mortality/trendsAged 80 and overDeveloped Countries/statistics & numerical dataDeveloping Countries/statistics & numerical dataRespirationDeveloped CountriesArticlesGeneral Medicineacute respiratory distress syndromeLength of StayMiddle AgedRespiration ArtificialIntensive Care UnitsObservational Studies as Topiclnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]Length of Stay/statistics & numerical dataArtificialIntensive Care Units/statistics & numerical dataIncomeFemaleARDS
researchProduct

Additional file 1 of The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal su…

2021

Additional file 1: Table 1. Patient and surgery related characteristics. Table 2. Intraoperative venitlatory setting by group.

researchProduct

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications:LAS VEGAS - An observationa…

2017

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative venti…

MalePediatricsInternationalityRESPIRATORY-DISTRESS-SYNDROME0302 clinical medicinePostoperative Complications030202 anesthesiologyRisk FactorsEpidemiologyABDOMINAL-SURGERY80 and overMedicine and Health SciencesGeneral anaesthesiaAnesthesiaEND-EXPIRATORY-PRESSUREBERLIN DEFINITION030212 general & internal medicineProspective StudiesProspective cohort studyLungAged 80 and overFramingham Risk ScoreIncidence (epidemiology)RespirationMiddle AgedTreatment OutcomeArtificialFemalePRACTICE PATTERNSHumanmedicine.medical_specialtymechanical ventilation ; prospective observational study ; Intensive careAnesthesia GeneralNONCARDIOTHORACIC SURGERYNOAged; Aged 80 and over; Anesthesia General; Cross-Sectional Studies; Female; Humans; Intraoperative Care; Lung; Male; Middle Aged; Postoperative Complications; Prospective Studies; Respiration Disorders; Respiration Artificial; Risk Factors; Tidal Volume; Treatment Outcome; Internationality; Anesthesiology and Pain MedicineACUTE LUNG INJURY03 medical and health sciencesGENERAL-ANESTHESIAInternal medicinemedicineJournal ArticleTidal VolumeHumansMED/41 - ANESTESIOLOGIAGeneralAgedCross-Sectional StudieIntraoperative Carebusiness.industryRisk FactorRespiration DisorderRespiration DisordersRespiration ArtificialConfidence intervalPROTECTIVE MECHANICAL VENTILATIONProspective StudieAnesthesiology and Pain MedicineCross-Sectional StudiesRelative riskMAJOR NONCARDIAC SURGERYPostoperative ComplicationbusinessAbdominal surgery
researchProduct

Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol…

2017

Background Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients. Methods/design The PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients (PROBESE) study is a multice…

MaleLung DiseasesTime Factors[SDV]Life Sciences [q-bio]Respiratory Medicine and Allergymedicine.medical_treatmentRESPIRATORY-DISTRESS-SYNDROMEMedicine (miscellaneous)HemodynamicsMechanical ventilation; Obesity; Positive end-expiratory pressure; Postoperative pulmonary complication; Recruitment maneuver; Medicine (miscellaneous); Pharmacology (medical)LAPAROSCOPIC BARIATRIC SURGERYLung DiseaseBody Mass Indexlaw.inventionPositive-Pressure RespirationStudy Protocol0302 clinical medicineMechanical ventilationClinical ProtocolsRandomized controlled trialRisk Factors030202 anesthesiologylawMedicine and Health SciencesClinical endpointAnesthesiaPharmacology (medical)Respiratory function030212 general & internal medicineLungLungmedicin och allergi2. Zero hungerlcsh:R5-920ddc:617Positive end-expiratory pressurerespiratory systemOperative3. Good healthTreatment OutcomeRecruitment maneuverTIDAL VOLUMESResearch DesignMechanical ventilation Positive end-expiratory pressure Recruitment maneuver Obesity Postoperative pulmonary complicationSurgical Procedures OperativeAnesthesiaBreathingFemaleErratumlcsh:Medicine (General)ALVEOLAR RECRUITMENT MANEUVERHumancirculatory and respiratory physiologymedicine.medical_specialtyTime FactorMechanical ventilation ; Obesity ; Positive end-expiratory pressure ; Postoperative pulmonary complication ; Recruitment maneuverAnesthesia GeneralLung injuryMechanical ventilation; Obesity; Positive end-expiratory pressure; Postoperative pulmonary complication; Recruitment maneuver; Body Mass Index; Clinical Protocols; Female; Humans; Intraoperative Care; Lung; Lung Diseases; Male; Obesity; Positive-Pressure Respiration; Protective Factors; Research Design; Risk Factors; Time Factors; Treatment Outcome; Anesthesia General; Surgical Procedures Operative; Medicine (miscellaneous); Pharmacology (medical)NOGENERAL-ANESTHESIADRIVING PRESSURE03 medical and health sciencesmedicineHumansddc:610ObesityClinical ProtocolGeneralProtective FactorPositive end-expiratory pressurePOSTOPERATIVE PULMONARY COMPLICATIONSMechanical ventilationSurgical ProceduresIntraoperative CareINTERNATIONAL CONSENSUSbusiness.industryRisk FactorProtective FactorsSurgeryMechanical ventilation; Obesity; Positive end-expiratory pressure; Postoperative pulmonary complication; Recruitment maneuverrespiratory tract diseasesbusinessPostoperative pulmonary complicationLUNG INJURY
researchProduct

Additional file 2 of The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal su…

2021

Additional file 2: Table S1. Definition of postoperative pulmonary complications. Table S2. Definition of intraoperative complications. Table S3. Number of data available at each time point. Table S4. Patients demographics and surgery–related characteristics in the matched cohort for type of surgery. Table S5. Intraoperative and postoperative outcomes in matched cohort for type of surgery. Table S6. Mixed multivariable logistic regression in matched cohort for postoperative pulmonary complications. Figure S1. Time weighted average and coefficient of variation calculation. Figure S2. Summary plot of covariate balance for time-weighted ΔP before (red line) and after (blue line) conditioning f…

researchProduct

Additional file 1 of Intraoperative ventilator settings and their association with postoperative pulmonary complications in neurosurgical patients: p…

2020

Additional file 1.

Data_FILES
researchProduct