• Innovation
    Promotion of technological and clinical innovation in critical care
  • Grip
    In-vitro and in-vivo research adherent to clinical practice and relevant for ICU every-day activities
  • Sharing
    International spread of ideas, innovation and research

Innovation

Promotion of technological and clinical innovation in critical care

Grip

In-vitro and in-vivo research adherent to clinical practice and relevant for ICU
every-day activities

Sharing

International spread of ideas, innovation and research

Our philosophy

The GRIP (Group for Research in Intensive care in Pavia) is founded in 2015 by a group of intensivists working at Intensive Care Units of Policlinico S. Matteo in Pavia. We are a group of young doctors and researchers who dedicated in the last years great energy, enthusiasm and time to develop new ideas, improve technology and optimize quality of care for critical patients. Our group is characterized by strong international connections for both clinical research and technological developement. Our missions are:

 

  1. 1
    Innovation

    Intensive care units are highly technological; therefore, development of innovative instruments and optimization of existing ones can have a deep clinical impact. We have strong national and international collaborations with research and development sections of industries involved in the field and with many universities in order to push technology forward.

  2. 2
    Grip

    Our aim is to promote and support a research projects gripping the real world. First, this means we support research with high clinical impact and strong everyday applicability. Second, we support researchers, offering work possibilities for young professionals.

  3. 3
    Sharing

    We aim to share our ideas, projects and results with scientific community; we have strong national and international research cooperation and  researcher exchange programs with multiple university centers.

News

Tidal lung hysteresis to interpret PEEP-induced changes in compliance in ARDS patients

screenshot-2023-06-14-at-21-46-30

Lung hysteresis in a decremental PEEP trial helps identifying tidal recruitment and optimise the setting of PEEP in a personalised mechanical ventilation.
Full test on Critical Care here

Abstract

Background

In ARDS, the PEEP level associated with the best respiratory system compliance is often selected; however, intra-tidal recruitment can increase compliance, falsely suggesting improvement in baseline mechanics. Tidal lung hysteresis increases with intra-tidal recruitment and can help interpreting changes in compliance. This study aims to assess tidal recruitment in ARDS patients and to test a combined approach, based on tidal hysteresis and compliance, to interpret decremental PEEP trials.

Methods

A decremental PEEP trial was performed in 38 COVID-19 moderate to severe ARDS patients. At each step, we performed a low-flow inflation-deflation manoeuvre between PEEP and a constant plateau pressure, to measure tidal hysteresis and compliance.

Results

According to changes of tidal hysteresis, three typical patterns were observed: 10 (26%) patients showed consistently high tidal-recruitment, 12 (32%) consistently low tidal-recruitment and 16 (42%) displayed a biphasic pattern moving from low to high tidal-recruitment below a certain PEEP. Compliance increased after 82% of PEEP step decreases and this was associated to a large increase of tidal hysteresis in 44% of cases. Agreement between best compliance and combined approaches was accordingly poor (K = 0.024). The combined approach suggested to increase PEEP in high tidal-recruiters, mainly to keep PEEP constant in biphasic pattern and to decrease PEEP in low tidal-recruiters. PEEP based on the combined approach was associated with lower tidal hysteresis (92.7 ± 20.9 vs. 204.7 ± 110.0 mL; p < 0.001) and lower dissipated energy per breath (0.1 ± 0.1 vs. 0.4 ± 0.2 J; p < 0.001) compared to the best compliance approach. Tidal hysteresis ≥ 100 mL was highly predictive of tidal recruitment at next PEEP step reduction (AUC 0.97; p < 0.001).

Conclusions

Assessment of tidal hysteresis improves the interpretation of decremental PEEP trials and may help limiting tidal recruitment and energy dissipated into the respiratory system during mechanical ventilation of ARDS patients.
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