Katerina Vaporidi

University of Crete, Retimo, Crete, Greece

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Publications (22)98.61 Total impact

  • No preview · Article · Oct 2015
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    ABSTRACT: AEGLE project targets to build an innovative ICT solution addressing the whole data value chain for health based on: cloud computing enabling dynamic resource allocation, HPC infrastructures for computational acceleration and advanced visualization techniques. In this paper, we provide an analysis of the addressed Big Data health scenarios and we describe the key enabling technologies, as well as data privacy and regulatory issues to be integrated into AEGLE's ecosystem, enabling advanced health-care analytic services, while also promoting related research activities.
    Full-text · Conference Paper · Jul 2015
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    Full-text · Article · Mar 2015 · Critical Care
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    ABSTRACT: Mechanical stress induced by injurious ventilation leads to pro-inflammatory cytokine production and lung injury. The extracellular-signal-regulated-kinase, ERK1/2, participates in the signaling pathways activated upon mechanical stress in the lungs to promote the inflammatory response. Tumor progression locus 2 (Tpl2) is a MAP3kinase that activates ERK1/2 upon cytokine or TLR signaling, to induce pro-inflammatory cytokine production. The role of Tpl2 in lung inflammation, and specifically in the one caused by mechanical stress has not been investigated. The aim of the study was to examine if genetic or pharmacologic inhibition of Tpl2 could ameliorate ventilator-induced lung injury. Adult male wild-type and Tpl2-deficient mice were ventilated with normal or high tidal volume for 4 h. Additional wild-type mice were treated with a Tpl2 inhibitor either before or 30 min after initiation of high tidal ventilation. Non-ventilated mice of both genotypes served as controls. The development of lung injury was evaluated by measuring lung mechanics, arterial blood gases, concentrations of proteins, IL-6, and MIP-2 in bronchoalveolar lavage fluid (BALF) and by lung histology. Data were compared by Kruskal-Wallis non-parametric test and significance was defined as p < 0.05. Mechanical ventilation with normal tidal volume induced a mild increase of IL-6 in BALF in both strains. High tidal volume ventilation induced lung injury in wild-type mice, characterized by decreased lung compliance, increased concentrations of proteins, IL-6 and MIP-2 in BALF, and inflammatory cell infiltration on histology. All indices of lung injury were ameliorated in Tpl2-deficient mice. Wild-type mice treated with the Tpl2 inhibitor, either prior of after the initiation of high tidal volume ventilation were protected from the development of lung injury, as indicated by preserved lung compliance and lower BALF concentrations of proteins and IL-6, than similarly ventilated, untreated wild-type mice. Genetic and pharmacologic inhibition of Tpl2 is protective in a mouse model of ventilator-induced lung injury, ameliorating both high-permeability pulmonary edema and lung inflammation.
    Full-text · Article · May 2014
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    ABSTRACT: Acute respiratory distress syndrome (ARDS) is a major cause of respiratory failure, with limited effective treatments available. Alveolar macrophages participate in the pathogenesis of ARDS. To investigate the role of macrophage activation in aseptic lung injury and identify molecular mediators with therapeutic potential, lung injury was induced in wild-type (WT) and Akt2(-/-) mice by hydrochloric acid aspiration. Acid-induced lung injury in WT mice was characterized by decreased lung compliance and increased protein and cytokine concentration in bronchoalveolar lavage fluid. Alveolar macrophages acquired a classical activation (M1) phenotype. Acid-induced lung injury was less severe in Akt2(-/-) mice compared with WT mice. Alveolar macrophages from acid-injured Akt2(-/-) mice demonstrated the alternative activation phenotype (M2). Although M2 polarization suppressed aseptic lung injury, it resulted in increased lung bacterial load when Akt2(-/-) mice were infected with Pseudomonas aeruginosa. miR-146a, an anti-inflammatory microRNA targeting TLR4 signaling, was induced during the late phase of lung injury in WT mice, whereas it was increased early in Akt2(-/-) mice. Indeed, miR-146a overexpression in WT macrophages suppressed LPS-induced inducible NO synthase (iNOS) and promoted M2 polarization, whereas miR-146a inhibition in Akt2(-/-) macrophages restored iNOS expression. Furthermore, miR-146a delivery or Akt2 silencing in WT mice exposed to acid resulted in suppression of iNOS in alveolar macrophages. In conclusion, Akt2 suppression and miR-146a induction promote the M2 macrophage phenotype, resulting in amelioration of acid-induced lung injury. In vivo modulation of macrophage phenotype through Akt2 or miR-146a could provide a potential therapeutic approach for aseptic ARDS; however, it may be deleterious in septic ARDS because of impaired bacterial clearance.
    Preview · Article · Nov 2013 · The Journal of Immunology

  • No preview · Conference Paper · Oct 2013
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    ABSTRACT: The aim of this study was to investigate the changes induced by high tidal volume ventilation (HVTV) in pulmonary expression of micro-RNAs (miRNAs) and identify potential target genes and corresponding miRNA-gene networks. Using a real-time RT-PCR-based array in RNA samples from lungs of mice subjected to HVTV for 1 or 4 h and control mice, we identified 65 miRNAs whose expression changed more than twofold upon HVTV. An inflammatory and a TGF-β-signaling miRNA-gene network were identified by in silico pathway analysis being at highest statistical significance (P = 10(-43) and P = 10(-28), respectively). In the inflammatory network, IL-6 and SOCS-1, regulated by miRNAs let-7 and miR-155, respectively, appeared as central nodes. In TGF-β-signaling network, SMAD-4, regulated by miR-146, appeared as a central node. The contribution of miRNAs to the development of lung injury was evaluated in mice subjected to HVTV treated with a precursor or antagonist of miR-21, a miRNA highly upregulated by HVTV. Lung compliance was preserved only in mice treated with anti-miR-21 but not in mice treated with pre-miR-21 or negative-control miRNA. Both alveolar-arterial oxygen difference and protein levels in bronchoalveolar lavage were lower in mice treated with anti-miR-21 than in mice treated with pre-miR-21 or negative-control miRNA (D(A-a): 66 ± 27 vs. 131 ± 22, 144 ± 10 mmHg, respectively, P < 0.001; protein concentration: 1.1 ± 0.2 vs. 2.3 ± 1, 2.1 ± 0.4 mg/ml, respectively, P < 0.01). Our results show that HVTV induces changes in miRNA expression in mouse lungs. Modulation of miRNA expression can affect the development of HVTV-induced lung injury.
    Full-text · Article · Jun 2012 · AJP Lung Cellular and Molecular Physiology
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    ABSTRACT: Activated macrophages are described as classically activated or M1 type and alternatively activated or M2 type, depending on their response to proinflammatory stimuli and the expression of genetic markers including iNOS, arginase1, Ym1, and Fizz1. Here we report that Akt kinases differentially contribute to macrophage polarization, with Akt1 ablation giving rise to an M1 and Akt2 ablation resulting in an M2 phenotype. Accordingly, Akt2(-/-) mice were more resistant to LPS-induced endotoxin shock and to dextran sulfate sodium (DSS)-induced colitis than wild-type mice, whereas Akt1(-/-) mice were more sensitive. Cell depletion and reconstitution experiments in a DSS-induced colitis model confirmed that the effect was macrophage-dependent. Gene-silencing studies showed that the M2 phenotype of Akt2(-/-) macrophages was cell autonomous. The microRNA miR-155, whose expression was repressed in naive and in LPS-stimulated Akt2(-/-) macrophages, and its target C/EBPβ appear to play a key role in this process. C/EBPβ, a hallmark of M2 macrophages that regulates Arg1, was up-regulated upon Akt2 ablation or silencing. Overexpression or silencing of miR-155 confirmed its central role in Akt isoform-dependent M1/M2 polarization of macrophages.
    Full-text · Article · May 2012 · Proceedings of the National Academy of Sciences
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    ABSTRACT: The antiinflammatory effects of hydrogen sulfide (H2S) and sodium sulfide (Na2S) treatment may prevent acute lung injury induced by high tidal volume (HVT) ventilation. However, lung protection may be limited by direct pulmonary toxicity associated with H2S inhalation. Therefore, the authors tested whether the inhalation of H2S or intravascular Na2S treatment can protect against ventilator-induced lung injury in mice. Anesthetized mice continuously inhaled 0, 1, 5, or 60 ppm H2S or received a single bolus infusion of Na2S (0.55 mg/kg) or vehicle and were then subjected to HVT (40 ml/kg) ventilation lasting 4 h (n = 4-8 per group). HVT ventilation increased the concentrations of protein and interleukin-6 in bronchoalveolar lavage fluid, contributing to reduced respiratory compliance and impaired arterial oxygenation, and caused death from lung injury and pulmonary edema. Inhalation of 1 or 5 ppm H2S during HVT ventilation did not alter lung injury, but inhalation of 60 ppm H2S accelerated the development of ventilator-induced lung injury and enhanced the pulmonary expression of the chemoattractant CXCL-2 and the leukocyte adhesion molecules CD11b and L-selectin. In contrast, pretreatment with Na2S attenuated the expression of CXCL-2 and CD11b during HVT ventilation and reduced pulmonary edema. Moreover, Na2S enhanced the pulmonary expression of Nrf2-dependent antioxidant genes (NQO1, GPX2, and GST-A4) and prevented oxidative stress-induced depletion of glutathione in lung tissue. The data suggest that systemic intravascular treatment with Na2S represents a novel therapeutic strategy to prevent both ventilator-induced lung injury and pulmonary glutathione depletion by activating Nrf2-dependent antioxidant gene transcription.
    No preview · Article · Sep 2011 · Anesthesiology
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    ABSTRACT: To compare the diagnostic performance of lung ultrasound and bedside chest radiography (CXR) for the detection of various pathologic abnormalities in unselected critically ill patients, using thoracic computed tomography (CT) as a gold standard. Forty-two mechanically ventilated patients scheduled for CT were prospectively studied with a modified lung ultrasound protocol. Four pathologic entities were evaluated: consolidation, interstitial syndrome, pneumothorax, and pleural effusion. Each hemithorax was evaluated for the presence or absence of each abnormality. Eighty-four hemithoraces were evaluated by the three imaging techniques. The sensitivity, specificity, and diagnostic accuracy of CXR were 38, 89, and 49% for consolidation, 46, 80, and 58% for interstitial syndrome, 0, 99, and 89% for pneumothorax, and 65, 81, and 69% for pleural effusion, respectively. The corresponding values for lung ultrasound were 100, 78, and 95% for consolidation, 94, 93, and 94% for interstitial syndrome, 75, 93, and 92% for pneumothorax, and 100, 100, and 100% for pleural effusion, respectively. The relatively low sensitivity of lung ultrasound for pneumothorax could be due to small number of cases (n = 8) and/or suboptimal methodology. In our unselected general ICU population lung ultrasound has a considerably better diagnostic performance than CXR for the diagnosis of common pathologic conditions and may be used as an alternative to thoracic CT.
    Full-text · Article · Sep 2011 · Intensive Care Medicine
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    ABSTRACT: In mechanically ventilated patients with COPD, the response of the expiratory resistance of the respiratory system (expiratory R(RS)) to bronchodilators is virtually unknown. To examine the effect of inhaled albuterol on expiratory R(RS), and the correlation of albuterol-induced changes in expiratory R(RS) with end-inspiratory resistance and the expiratory flow-volume relationship. We studied 10 mechanically ventilated patients with COPD exacerbation, before and 30 min after administration of albuterol. We obtained flow-volume curves during passive expiration, divided the expired volume into 5 equal volume slices, and then calculated the time constant and dynamic effective deflation compliance of the respiratory system (effective deflation C(RS)) of each slice via regression analysis of the volume-flow and post-occlusion volume-tracheal pressure relationships, respectively. For each slice we calculated expiratory R(RS) as the time constant divided by the effective deflation C(RS). Albuterol significantly decreased the expiratory R(RS) (mean expiratory R(RS) 42.68 ± 17.8 cm H(2)O/L/s vs 38.08 ± 16.1 cm H(2)O/L/s) and increased the rate of lung emptying toward the end of expiration (mean time constant 2.51 ± 1.2 s vs 2.21 ± 1.2 s). No correlation was found between the albuterol-induced changes in expiratory R(RS) and that of end-inspiratory resistance. Only at the end of expiration did albuterol-induced changes in the expiratory flow-volume relationship correlate with changes in expiratory R(RS) in all patients. In patients with COPD, albuterol significantly decreases expiratory resistance at the end of expiration. In mechanically ventilated patients, neither inspiratory resistance nor the whole expiratory flow-volume curve may be used to evaluate the bronchodilator response of expiratory resistance.
    Full-text · Article · May 2011 · Respiratory care
  • M Klimathianaki · K Vaporidi · D Georgopoulos
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    ABSTRACT: Respiratory muscle dysfunction is a cardinal feature of acute and chronic respiratory failure in COPD. Diaphragm and accessory inspiratory muscles face increased load due to increased lung resistance and elastance, as well as increased ventilatory demands. Concomitantly, the capacity of the inspiratory muscles to generate pressure is decreased due to mechanical disadvantage imposed by hyperinflation. Additionally, inflammation and oxidative stress impair muscle fiber specific force generation and increase diaphragm susceptibility to sarcomer disruption during acute inspiratory loading. In response to this increased load diaphragm presents unique adaptations in its cellular structure and passive and contractile mechanical properties, and displays a more efficient metabolic armamentarium. A shift of muscle fiber type towards slow-twitch, oxidative type I fibers, which are more fatigue-resistant, increases diaphragmatic endurance but protein degradation and a significant reduction in myosin content decrease its force generating capacity. Furthermore, diaphragm adapts to chronic hyperinflation by sarcomere deletion so that its overall length is shortened, in an attempt to preserve optimum force-length relationship. Adaptation however may not be complete, or may be overwhelmed by pathophysiologic derangements during exercise or acute exacerbations, leading to obvious "dysfunction" of the respiratory muscles, and if sustained, ultimately to muscle fatigue and respiratory pump failure.
    No preview · Article · Apr 2011 · Current drug targets
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    Katerina Vaporidi · Roland C Francis · Kenneth D Bloch · Warren M Zapol
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    ABSTRACT: Nitric oxide synthase (NOS) depletion or inhibition reduces ventilator-induced lung injury (VILI), but the responsible mechanisms remain incompletely defined. The aim of this study was to elucidate the role of endothelial NOS, NOS3, in the pathogenesis of VILI in an in vivo mouse model. Wild-type and NOS3-deficient mice were ventilated with high-tidal volume (HV(T); 40 ml/kg) for 4 h, with and without adding NO to the inhaled gas. Additional wild-type mice were pretreated with tetrahydrobiopterin and ascorbic acid, agents that can prevent NOS-generated superoxide production. Arterial blood gas tensions, histology, and lung mechanics were evaluated after 4 h of HV(T) ventilation. The concentration of protein, IgM, cytokines, malondialdehyde, and 8-isoprostane were measured in bronchoalveolar lavage fluid (BALF). Myeloperoxidase activity, total and oxidized glutathione levels, and NOS-derived superoxide production were measured in lung tissue homogenates. HV(T) ventilation induced VILI in wild-type mice, as reflected by decreased lung compliance, increased concentrations of protein and cytokines in BALF, and oxidative stress. All indices of VILI were ameliorated in NOS3-deficient mice. Augmenting pulmonary NO levels by breathing NO during mechanical ventilation did not increase lung injury in NOS3-deficient mice. HV(T) ventilation increased NOS-inhibitable superoxide production in lung extracts from wild-type mice but not in those from NOS3-deficient mice. Administration of tetrahydrobiopterin and ascorbic acid ameliorated VILI in wild-type mice. Our results indicate that NOS3 contributes to ventilator-induced lung injury via increased production of superoxide.
    Preview · Article · May 2010 · AJP Lung Cellular and Molecular Physiology
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    ABSTRACT: Recently, a new technology has been introduced aiming to monitor and improve patient ventilator interaction (PVI monitor). With the PVI monitor, a signal representing an estimation of the patient's total inspiratory muscle pressure (Pmus(PVI)) is calculated from the equation of motion, utilizing estimated values of resistance and elastance of the respiratory system. The aim of the study was to prospectively examine the accuracy of Pmus(PVI) to quantify inspiratory muscle pressure. Eleven critically ill patients mechanically ventilated on proportional assist ventilation with load-adjustable gain factors were studied at three levels of assist (30, 50 and 70%). Airway, esophageal, gastric and transdiaphragmatic (Pdi) pressures, volume and flow were measured breath by breath, whereas the total inspiratory muscle pressure (Pmus) was calculated using the Campbell diagram. For a given assist, Pmus(PVI) throughout inspiration did not differ from the corresponding values calculated using the Pdi and Pmus signals. Inspiratory and expiratory time did not differ among the various methods of calculation. Inspiratory muscle pressure decreased with increasing assist, and the magnitude of this decrease did not differ among the various methods of pressure calculation. A signal generated from flow, volume and airway pressure may be used to provide breath-by-breath quantitative information of inspiratory muscle pressure.
    No preview · Article · Apr 2010 · Intensive Care Medicine
  • K Vaporidi · KD Bloch · WM Zapol

    No preview · Conference Paper · Apr 2009
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    ABSTRACT: Clinical studies using both polysomnographic data and patient's perception have shown a poor quality of sleep among mechanically ventilated patients, which may have cardiorespiratory, neurological, immunological and metabolic consequences. Pre-existing medical or chronic sleep disorders, severity of illness, the acute illness that precipitated the ICU admission, the ICU environment, alterations in circadian rhythm, sedatives and mechanical ventilation per. se may be causes of poor sleep in these patients. Mechanical ventilation can disrupt sleep either by producing periodic breathing and central apnoeas or by promoting patient-ventilator dysynchrony. Excessive assist during ventilation on conventional modes may lead to the development of central apnoeas by decreasing PaC02, the main determinant that controls breathing during sleep or sedation. New modes of assisted mechanical ventilation that promote the synchrony between the patient and ventilator have been introduced and may reduce sleep disruption.
    No preview · Article · Sep 2008 · International Journal of Intensive Care
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    ABSTRACT: It is not known if proportional assist ventilation with load-adjustable gain factors (PAV+) may be used as a mode of support in critically ill patients. The aim of this study was to examine the effectiveness of sustained use of PAV+ in critically ill patients and compare it with pressure support ventilation (PS). Randomized study in the intensive care unit of a university hospital. A total of 208 critically ill patients mechanically ventilated on controlled modes for at least 36 h and meeting certain criteria were randomized to receive either PS (n = 100) or PAV+ (n = 108). Specific written algorithms were used to adjust the ventilator settings in each mode. PAV+ or PS was continued for 48 h unless the patients met pre-defined criteria either for switching to controlled modes (failure criteria) or for breathing without ventilator assistance. Failure rate was significantly lower in PAV+ than that in PS (11.1 vs. 22.0%, P = 0.040, OR 0.443, 95% CI 0.206-0.952). The proportion of patients exhibiting major patient-ventilator dyssynchronies at least during one occasion and after adjusting the initial ventilator settings, was significantly lower in PAV+ than in PS (5.6 vs. 29.0%, P < 0.001, OR 0.1, 95% CI 0.06-0.4). The proportion of patients meeting criteria for unassisted breathing did not differ between modes. PAV+ may be used as a useful mode of support in critically ill patients. Compared to PS, PAV+ increases the probability of remaining on spontaneous breathing, while it considerably reduces the incidence of patient-ventilator asynchronies.
    Full-text · Article · Aug 2008 · Intensive Care Medicine
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    ABSTRACT: The aim of this study was to evaluate the effects of respiratory rate (RR) at a constant PaCO2 and conventional tidal volume (VT) on the development of ventilator-induced lung injury in normal lungs. Prospective, randomized, experimental study. University research laboratory. Adult male C57BL/6 mice. Four groups of anesthetized mice were exposed to mechanical ventilation with different RRs and VTs. Three groups were assigned to one of three RRs (80, 120, and 160 breaths/min), and VT was set to 12, 10, and 8 mL/kg, respectively (RR80 VT12, RR120 VT10, and RR160 VT8), to achieve normal PaCO2. A fourth group was ventilated at 160 breaths/min and VT of 10 mL/kg (RR160 VT10) with adjustment of dead space. All animals were ventilated for 120 mins with a positive end-expiratory pressure of 1.5 cm H2O and FiO2 of 1. Nonventilated animals were also studied. Arterial blood gases and static pressure-volume curves were not different among groups at the end of the experiment. Independent of ventilator settings, mechanical ventilation was associated with increased bronchoalveolar lavage protein and increased bronchoalveolar lavage and serum interleukin-6. Total bronchoalveolar lavage protein and interleukin-6 were significantly lower in RR80 VT12 and RR160 VT8 compared with RR120 VT10 and RR160 VT10. In all experimental conditions, mechanical ventilation was associated with activation of AKT and ERK1/2 kinases, known to be activated on stretch. Phosphorylation both of AKT and ERK1/2 was lower in RR80 VT12 compared with other groups of ventilated animals. Histologic injury did not differ among nonventilated, RR80 VT12, and RR160 VT8 animals; however, it increased significantly and progressively in RR120 VT10 and RR160 VT10 animals. Mechanical ventilation with conventional VT induces lung injury in normal lungs, even without alteration in lung mechanics. Reduction of RR and VT ameliorates lung inflammation and injury.
    No preview · Article · May 2008 · Critical care medicine
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    ABSTRACT: The protein kinase encoded by the Tpl2 protooncogene plays an obligatory role in the transduction of Toll-like receptor and death receptor signals in macrophages, B cells, mouse embryo fibroblasts, and epithelial cells in culture and promotes inflammatory responses in animals. To address its role in T cell activation, we crossed the T cell receptor (TCR) transgene 2C, which recognizes class I MHC presented peptides, into the Tpl2(-/-) genetic background. Surprisingly, the TCR2C(tg/tg)/Tpl2(-/-) mice developed T cell lymphomas with a latency of 4-6 months. The tumor cells were consistently TCR2C(+)CD8(+)CD4(-), suggesting that they were derived either from chronically stimulated mature T cells or from immature single positive (ISP) cells. Further studies showed that the population of CD8(+) ISP cells was not expanded in the thymus of TCR2C(tg/tg)/Tpl2(-/-) mice, making the latter hypothesis unlikely. Mature peripheral T cells of Tpl2(-/-) mice were defective in ERK activation and exhibited enhanced proliferation after TCR stimulation. The same cells were defective in the induction of CTLA4, a negative regulator of the T cell response, which is induced by TCR signals via ERK. These findings suggest that Tpl2 functions normally in a feedback loop that switches off the T cell response to TCR stimulation. As a result, Tpl2, a potent oncogene, functions as a tumor suppressor gene in chronically stimulated T cells.
    Preview · Article · Mar 2008 · Proceedings of the National Academy of Sciences
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    ABSTRACT: During pressure support ventilation (PS), an abrupt increase in ventilator pressure above the pre-set level is considered to signify expiratory muscle activity. However, relaxation of inspiratory muscles may also cause the same phenomenon, and this hypothesis has not been explored. The aim of this study is to examine the cause of this increase in ventilator pressure, during PS, in critically ill patients. Retrospective study. In a university intensive care unit. Fifteen patients instrumented with esophageal and gastric balloons, and in whom airway pressure (P (aw)) during PS exhibited an acute increase above the pre-set level towards the end of mechanical inspiration were retrospectively analyzed. For each breath, the time of the rapid increase in P (aw) was identified (t (Paw)) and, using the transdiaphragmatic (P (di)) and gastric (P (ga)) pressure waveforms, related to: (1) the end of neural inspiration (peak P (di)) and (2) the time at which P (ga) started to increase rapidly after the end of neural inspiration indicating expiratory muscle recruitment. The t (Paw) was observed 32+/-34ms after the end of neural inspiration, well before (323+/-182ms) expiratory muscle recruitment (identified in eight patients). There was a significant linear relationship between the rate of rise of P (aw) after t (Paw) and the rates of decline of P (di) and inspiratory flow. We conclude that, during PS ventilation, the relaxation of inspiratory muscles accounts for the acute increase in P (aw) above the pre-set level, in addition to the contribution made by the occurrence of expiratory muscle activity.
    No preview · Article · Feb 2008 · Intensive Care Medicine

Publication Stats

497 Citations
98.61 Total Impact Points


  • 2006-2014
    • University of Crete
      • Department of Intensive Care Medicine
      Retimo, Crete, Greece
  • 2012
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2008
    • Tufts Medical Center
      • Molecular Oncology Research Institute
      Boston, MA, United States
  • 2007
    • University Hospital of Heraklion
      • Department of Gastroenterology
      Irákleio, Attica, Greece