DSpace Repository :: Browsing by Author "Gogniat, Emiliano"

Browsing by Author "Gogniat, Emiliano"

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Automatic detection of reverse‑triggering related asynchronies during mechanical ventilation in ARDS patients using flow and pressure signals
(2019) Rodríguez, Pablo Oscar; Tiribelli, Norberto; Gogniat, Emiliano; Plotnikow, Gustavo A.; Fredes, Sebastián; Fernández Ceballos, Ignacio; Pratto, Romina A.; Madorno, Matías; Ilutovich, Santiago; San Román, Eduardo; Bonelli, Ignacio; Guaymas, María; Raimondi, Alejandro C.; Maskin, Luis Patricio; Setten, Mariano
"Asynchrony due to reverse-triggering (RT) may appear in ARDS patients. The objective of this study is to validate an algo-rithm developed to detect these alterations in patient–ventilator interaction. We developed an algorithm that uses flow and airway pressure signals to classify breaths as normal, RT with or without breath stacking (BS) and patient initiated double-triggering (DT). The diagnostic performance of the algorithm was validated using two datasets of breaths, that are classified as stated above. The first dataset classification was based on visual inspection of esophageal pressure (Pes) signal from 699 breaths recorded from 11 ARDS patients. The other classification was obtained by vote of a group of 7 experts (2 physicians and 5 respiratory therapists, who were trained in ICU), who evaluated 1881 breaths gathered from recordings from 99 sub-jects. Experts used airway pressure and flow signals for breaths classification. The RT with or without BS represented 19% and 37% of breaths in Pes dataset while their frequency in the expert’s dataset were 3% and 12%, respectively. The DT was very infrequent in both datasets. Algorithm classification accuracy was 0.92 (95% CI 0.89–0.94, P < 0.001) and 0.96 (95% CI 0.95–0.97, P < 0.001), in comparison with Pes and experts’ opinion. Kappa statistics were 0.86 and 0.84, respectively. The algorithm precision, sensitivity and specificity for individual asynchronies were excellent. The algorithm yields an excellent accuracy for detecting clinically relevant asynchronies related to RT."
Dead space analysis at different levels of positive end-expiratory pressure in acute respiratory distress syndrome patients
(2018-06) Gogniat, Emiliano; Ducrey, Marcela; Dianti, José; Madorno, Matías; Roux, Nicolás; Midley, Alejandro; Raffo, Julio; Giannasi, Sergio; San Román, Eduardo; Suárez-Sipmann, Fernando; Tusman, Gerardo
"To analyze the effects of positive end-expiratory pressure (PEEP) on Bohr's dead space (VDBohr/VT) in patients with acute respiratory distress syndrome (ARDS)."
Effect of PEEP on dead space in an experimental model of ARDS
(2020) Tusman, Gerardo; Gogniat, Emiliano; Madorno, Matías; Otero, Pablo; Dianti, José; Fernández Ceballos, Ignacio; Ceballos, Martín; Verdier, Natalí; Böhm, Stephan H.; Rodríguez, Pablo Oscar; San Román, Eduardo
"Background: Difference between Bohr and Enghoff dead space are not well described in ARDS patients. We aimed to analyze the effect of PEEP on the Bohr and Enghoff dead spaces in a model of ARDS. Methods: 10 pigs submitted to randomized PEEP steps of 0, 5, 10, 15, 20, 25 and 30 cm H2O were evaluated with the use of lung ultrasound images, alveolar-arterial oxygen difference (P(A-a)O2), transpulmonary mechanics, and volumetric capnography at each PEEP step. Results: At PEEP > 15 cm H2O, atelectasis and P(A-a)O2 progressively decreased while endinspiratory transpulmonary pressure (PL), end-expiratory PL, and driving PL increased (all P < .001). Bohr dead space (VDBohr/VT), airway dead space (VDaw/VT), and alveolar dead space (VDalv/VTalv) reached their highest values at PEEP 30 cm H2O (0.69 0.10, 0.53 0.13 and 0.35 0.06, respectively). At PEEP <15 cm H2O, the increases in atelectasis and P(A-a)O2 were associated with negative end-expiratory PL and highest driving PL. VDBohr/VT and VDaw/VT showed the lowest values at PEEP 0 cm H2O (0.51 0.08 and 0.32 0.08, respectively), whereas VDalv/VTalv increased to 0.27 0.05. Enghoff dead space and its derived VDalv/VTalv showed high values at low PEEPs (0.86 0.02 and 0.79 0.04, respectively) and at high PEEPs (0.84 0.04 and 0.65 0.12), with the lowest values at 15 cm H2O (0.77 0.05 and 0.61 0.11, respectively; all P < .001). CONCLUSIONS: Bohr dead space was associated to lung stress, whereas Enghoff dead space was partially affected by the shunt effect. Key words: dead space; PEEP; lung stress; ARDS; VILI; carbon dioxide."
Multimodal non‑invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery
(2019) Tusman, Gerardo; Acosta, Cecilia M.; Ochoa, Marcos; Böhm, Stephan H.; Gogniat, Emiliano; Martínez Arca, Jorge; Scandurra, Adriana; Madorno, Matías; Ferrando, Carlos; Suárez-Sipmann, Fernando
"To evaluate the use of non-invasive variables for monitoring an open-lung approach (OLA) strategy in bariatric surgery. Twelve morbidly obese patients undergoing bariatric surgery received a baseline protective ventilation with 8 cmH2O of positive-end expiratory pressure (PEEP). Then, the OLA strategy was applied consisting in lung recruitment followed by a decremental PEEP trial, from 20 to 8 cmH2O, in steps of 2 cmH2O to find the lung’s closing pressure. Baseline ventila-tion was then resumed setting open lung PEEP (OL-PEEP) at 2 cmH2O above this pressure. The multimodal non-invasive variables used for monitoring OLA consisted in pulse oximetry (SpO2), respiratory compliance (Crs), end-expiratory lung volume measured by a capnodynamic method (EELVCO2), and esophageal manometry. OLPEEP was detected at 15.9 ± 1.7 cmH2O corresponding to a positive end-expiratory transpulmonary pressure (PL,ee) of 0.9 ± 1.1 cmH2O. ROC analysis showed that SpO2 was more accurate (AUC 0.92, IC95% 0.87–0.97) than Crs (AUC 0.76, IC95% 0.87–0.97) and EELVCO2 (AUC 0.73, IC95% 0.64–0.82) to detect the lung’s closing pressure according to the change of PL,ee from positive to negative values. Compared to baseline ventilation with 8 cmH2O of PEEP, OLA increased EELVCO2 (1309 ± 517 vs. 2177 ± 679 mL) and decreased driving pressure (18.3 ± 2.2 vs. 10.1 ± 1.7 cmH2O), estimated shunt (17.7 ± 3.4 vs. 4.2 ± 1.4%), lung strain (0.39 ± 0.07 vs. 0.22 ± 0.06) and lung elastance (28.4 ± 5.8 vs. 15.3 ± 4.3 cmH2O/L), respectively; all p < 0.0001. The OLA strategy can be monitored using noninvasive variables during bariatric surgery. This strategy decreased lung strain, elastance and driving pressure compared with standard protective ventilatory settings."
Prevalence of reverse triggering in early ARDS: results from a multicenter observational study
(2021-01) Rodríguez, Pablo Oscar; Tiribelli, Norberto; Fredes, Sebastián; Gogniat, Emiliano; Plotnikow, Gustavo A.; Fernández Ceballos, Ignacio; Pratto, Romina A.; Raimondi, Alejandro C.; Guaymas, María; Ilutovich, Santiago; San Román, Eduardo; Madorno, Matías; Maskin, Luis Patricio; Brochard, Laurent; Setten, Mariano
"Background: The prevalence of reverse triggering (RT) in the early phase of ARDS is unknown. Research question: During early ARDS, what is the proportion of patients affected by RT, what are its potential predictors, and what is its association with clinical outcomes? Study design and methods: This was prospective, multicenter, and observational study. Patients who met the Berlin definition of ARDS with less than 72 h of mechanical ventilation and had not been paralyzed with neuromuscular blockers were screened. A 30-min recording of respiratory signals was obtained from the patients as soon as they were enrolled, and the number of breaths with RT were counted."
Sizing the lung in dogs: the inspiratory capacity defines the tidal volume
(2018-06) Donati, Pablo Alejandro; Gogniat, Emiliano; Madorno, Matías; Guevara, Juan Manuel; Guillemi, Eliana Carolina; Lavalle, María del Carmen; Scorza, Francisco Patricio; Mayer, Germán Federico; Rodríguez, Pablo Oscar
"To evaluate a novel physiological approach for setting the tidal volume in mechanical ventilation according to inspiratory capacity, and to determine if it results in an appropriate mechanical and gas exchange measurements in healthy and critically ill dogs."

Browsing by Author "Gogniat, Emiliano"

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