Analysis of the introduction of a business process mapping system in Rosetti Marino spa

After a first theoric introduction about Business Process Re-engineering (BPR), are considered in particular the possible options found in literature regarding the following three macro-elements: the methodologies, the modelling notations and the tools employed for process mapping. The theoric section is the base for the analysis of the same elements into the specific case of Rosetti Marino S.p.A., an EPC contractor, operating in the Oil&Gas industry. Rosetti Marino implemented a tool developped internally in order to satisfy its needs in the most suitable way possible and buit a Map of all business processes,navigable on the Company Intranet. Moreover it adopted a methodology based upon participation, interfunctional communication and sharing. The GIGA introduction is analysed from a structural, human resources, political and symbolic point of view.

Advanced aspects of radiation protection in the use of particle accelerators in the medical field

In this work, the well-known MC code FLUKA was used to simulate the GE PETrace cyclotron (16.5 MeV) installed at “S. Orsola-Malpighi” University Hospital (Bologna, IT) and routinely used in the production of positron emitting radionuclides. Simulations yielded estimates of various quantities of interest, including: the effective dose distribution around the equipment; the effective number of neutron produced per incident proton and their spectral distribution; the activation of the structure of the cyclotron and the vault walls; the activation of the ambient air, in particular the production of 41Ar, the assessment of the saturation yield of radionuclides used in nuclear medicine. The simulations were validated against experimental measurements in terms of physical and transport parameters to be used at the energy range of interest in the medical field. The validated model was also extensively used in several practical applications uncluding the direct cyclotron production of non-standard radionuclides such as 99mTc, the production of medical radionuclides at TRIUMF (Vancouver, CA) TR13 cyclotron (13 MeV), the complete design of the new PET facility of “Sacro Cuore – Don Calabria” Hospital (Negrar, IT), including the ACSI TR19 (19 MeV) cyclotron, the dose field around the energy selection system (degrader) of a proton therapy cyclotron, the design of plug-doors for a new cyclotron facility, in which a 70 MeV cyclotron will be installed, and the partial decommissioning of a PET facility, including the replacement of a Scanditronix MC17 cyclotron with a new TR19 cyclotron.

Entwicklung und Anwendung massenspektrometrischer Methoden zur Spurenanalytik iodhaltiger Verbindungen und aliphatischer Amine in der marinen Umwelt

In der marinen Grenzschicht beeinflussen reaktive Iodspezies wie z.B. I2 sowie aliphatische Amine eine Vielzahl atmosphärischer Prozesse, vor allem bei der Partikelneubildung spielen sie eine entscheidende Rolle. Allerdings stellt die Quantifizierung dieser Verbindungen im Spurenbereich immer noch eine große analytische Herausforderung dar. rnAus diesem Grund wurde im Rahmen der vorliegenden Arbeit das GTRAP-AMS (Gaseous compound trapping in artificially generated particles – aerosol mass spectrometry) entwickelt, um gasförmiges I2 und aliphatische Amine zu bestimmen. Hierbei wird ein Flugzeit-Aerosolmassenspektrometer (ToF-AMS), das ursprünglich für die on-line Charakterisierung von Aerosolen entwickelt wurde, mit einer GTRAP-Einheit gekoppelt. Im Fall von I2 werden mit Hilfe eines pneumatischen Zerstäubers a-Cyclodextrin/NH4Br-Partikel erzeugt, die mit dem gasförmigen I2 innerhalb der GTRAP-Einheit eine Einschlussverbindung bilden und dieses dadurch selektiv in die Partikelphase aufnehmen. Für die on-line Bestimmung gasförmiger aliphatischer Amine dagegen wurde Phosphorsäure als partikulärer Reaktionspartner eingesetzt. Nach Optimierung des GTRAP-AMS Systems wurde sowohl für I2 als auch für die aliphatischen Amine eine Nachweisgrenze im sub-ppb-Bereich für eine Zeitauflösung zwischen 1 und 30 min erhalten. Als erstes wurde das GTRAP-AMS System zur Charakterisierung von Permanentdenudern eingesetzt, um deren I2-Aufnahmefähigkeit und Wiederverwendbarkeit im Vergleich zu den herkömmlichen einmal verwendbaren a-Cyclodextrin Denudern zu testen.rnIm Anschluss daran wurde das GTRAP-AMS für die Bestimmung zeitlich aufgelöster I2- Emissionsraten ausgewählter Makroalgen unter dem Einfluss von Ozon eingesetzt. Die Kenntnis der Emissionsraten iodhaltiger Verbindungen der wichtigsten weltweit vorkommenden Makroalgen ist für die Modellierung der Iodchemie in der marinen Grenzschicht von besonderer Bedeutung. Die Resultate zeigen, dass verschiedene Makroalgen sowohl unterschiedliche zeitlich aufgelöste I2-Emissionsprofile als auch Gesamtemissionsraten liefern. Im Vergleich zu den iodorganischen Verbindungen ist die Gesamtemissionsrate an I2 allerdings eine bis zwei Größenordnungen größer. Dies und die deutlich kürzere atmosphärische Lebensdauer von I2 im Vergleich zu den iodorganischen Verbindungen führen dazu, dass I2 die dominierende iodhaltige Verbindung für die Bildung reaktiver Iodatome in der marinen Grenzschicht ist. rnDa über dem tropischen Atlantischen Ozean bislang jedoch nur ein geringer Anteil der IO-Konzentration durch die Oxidation von iodorganischen Verbindungen erklärt werden kann, wurden weitere Quellen für I2 erforscht. Deshalb wurden Kammerexperimente mit Mikrolagen durchgeführt, um deren Einfluss auf die I2-Freisetzung in die Atmosphäre zu untersuchen. Hierbei konnte gezeigt werden, dass die Anwesenheit von Mikroalgen (z.B. Coscinodiscus Wailesii) im Meerwasser zu einer erhöhten Freisetzung von I2 aus dem Meerwasser in die Atmosphäre führen kann. rnDes Weiteren wurden auch Versuche zu abiotischen Bildungswegen von I2 durchgeführt. Die Ergebnisse der Atmosphärensimulationsexperimente haben gezeigt, dass partikuläre Iodoxide durch organische Verbindungen zu I2 reduziert werden können, welches im Anschluss von der Partikelphase in die Gasphase übergehen kann und dort wieder für Gasphasenprozesse zur Verfügung steht.rn

Transport of nanoparticles into polymersomes : a minimal model system of particles passage through biological membranes

This thesis focuses on the design and characterization of a novel, artificial minimal model membrane system with chosen physical parameters to mimic a nanoparticle uptake process driven exclusively by adhesion and softness of the bilayer. The realization is based on polymersomes composed of poly(dimethylsiloxane)-b-poly(2-methyloxazoline) (PMDS-b-PMOXA) and nanoscopic colloidal particles (polystyrene, silica), and the utilization of powerful characterization techniques. rnPDMS-b-PMOXA polymersomes with a radius, Rh ~100 nm, a size polydispersity, PD = 1.1 and a membrane thickness, h = 16 nm, were prepared using the film rehydratation method. Due to the suitable mechanical properties (Young’s modulus of ~17 MPa and a bending modulus of ~7⋅10-8 J) along with the long-term stability and the modifiability, these kind of polymersomes can be used as model membranes to study physical and physicochemical aspects of transmembrane transport of nanoparticles. A combination of photon (PCS) and fluorescence (FCS) correlation spectroscopies optimizes species selectivity, necessary for a unique internalization study encompassing two main efforts. rnFor the proof of concepts, the first effort focused on the interaction of nanoparticles (Rh NP SiO2 = 14 nm, Rh NP PS = 16 nm; cNP = 0.1 gL-1) and polymersomes (Rh P = 112 nm; cP = 0.045 gL-1) with fixed size and concentration. Identification of a modified form factor of the polymersome entities, selectively seen in the PCS experiment, enabled a precise monitor and quantitative description of the incorporation process. Combining PCS and FCS led to the estimation of the incorporated particles per polymersome (about 8 in the examined system) and the development of an appropriate methodology for the kinetics and dynamics of the internalization process. rnThe second effort aimed at the establishment of the necessary phenomenology to facilitate comparison with theories. The size and concentration of the nanoparticles were chosen as the most important system variables (Rh NP = 14 - 57 nm; cNP = 0.05 - 0.2 gL-1). It was revealed that the incorporation process could be controlled to a significant extent by changing the nanoparticles size and concentration. Average number of 7 up to 11 NPs with Rh NP = 14 nm and 3 up to 6 NPs with Rh NP = 25 nm can be internalized into the present polymersomes by changing initial nanoparticles concentration in the range 0.1- 0.2 gL-1. Rapid internalization of the particles by polymersomes is observed only above a critical threshold particles concentration, dependent on the nanoparticle size. rnWith regard possible pathways for the particle uptake, cryogenic transmission electron microscopy (cryo-TEM) has revealed two different incorporation mechanisms depending on the size of the involved nanoparticles: cooperative incorporation of nanoparticles groups or single nanoparticles incorporation. Conditions for nanoparticle uptake and controlled filling of polymersomes were presented. rnIn the framework of this thesis, the experimental observation of transmembrane transport of spherical PS and SiO2 NPs into polymersomes via an internalization process was reported and examined quantitatively for the first time. rnIn a summary the work performed in frames of this thesis might have significant impact on cell model systems’ development and thus improved understanding of transmembrane transport processes. The present experimental findings help create the missing phenomenology necessary for a detailed understanding of a phenomenon with great relevance in transmembrane transport. The fact that transmembrane transport of nanoparticles can be performed by artificial model system without any additional stimuli has a fundamental impact on the understanding, not only of the nanoparticle invagination process but also of the interaction of nanoparticles with biological as well as polymeric membranes. rn

Investigation of P3HT PCBM particle-based solar cells

Die Herstellung von Polymer-Solarzellen aus wässriger Phase stellt eine attraktive Alternative zu der konventionellen lösemittelbasierten Formulierung dar. Die Vorteile der aus wässriger Lösung hergestellten Solarzellen liegen besonders in dem umweltschonenden Herstellungsprozess und in der Möglichkeit, druckbare optoelektronische Bauteile zu generieren. Die Prozessierbarkeit von hydrophoben Halbleitern im wässrigen Milieu wird durch die Dispergierung der Materialien, in Form von Nanopartikeln, erreicht. Der Transfer der Halbleiter in eine Dispersion erfolgt über die Lösemittelverdampfungsmethode. Die Idee der Verwendung von partikelbasierte Solarzellen wurde bereits umgesetzt, allerdings blieben eine genaue Charakterisierung der Partikel sowie ein umfassendes Verständnis des gesamten Fabrikationsvorgangs aus. Deshalb besteht das Ziel dieser Arbeit darin, einen detaillierten Einblick in den Herstellungsprozess von partikelbasierten Solarzellen zu erlangen, mögliche Schwächen aufzudecken, diese zu beseitigen, um so zukünftige Anwendungen zu verbessern. Zur Herstellung von Solarzellen aus wässrigen Dispersionen wurde Poly(3-hexylthiophen-2,5-diyl)/[6,6]-Phenyl-C61-Buttersäure-Methylester (P3HT/PCBM) als Donor/Akzeptor-System verwendet. Die Kernpunkte der Untersuchungen richteten sich zum einen die auf Partikelmorphologie und zum anderen auf die Generierung einer geeigneten Partikelschicht. Beide Parameter haben Auswirkungen auf die Solarzelleneffizienz. Die Morphologie wurde sowohl spektroskopisch über Photolumineszenz-Messungen, als auch visuell mittels Elektronenmikroskopie ermittelt. Auf diese Weise konnte die Partikelmorphologie vollständig aufgeklärt werden, wobei Parallelen zu der Struktur von lösemittelbasierten Solarzellen gefunden wurden. Zudem wurde eine Abhängigkeit der Morphologie von der Präparationstemperatur beobachtet, was eine einfache Steuerung der Partikelstruktur ermöglicht. Im Zuge der Partikelschichtausbildung wurden direkte sowie grenzflächenvermittelnde Beschichtungsmethoden herangezogen. Von diesen Techniken hatte sich aber nur die Rotationsbeschichtung als brauchbare Methode erwiesen, Partikel aus der Dispersion in einen homogenen Film zu überführen. Des Weiteren stand die Aufarbeitung der Partikelschicht durch Ethanol-Waschung und thermische Behandlung im Fokus dieser Arbeit. Beide Maßnahmen wirkten sich positiv auf die Effizienz der Solarzellen aus und trugen entscheidend zu einer Verbesserung der Zellen bei. Insgesamt liefern die gewonnen Erkenntnisse einen detaillierten Überblick über die Herausforderungen, welche bei dem Einsatz von wasserbasierten Dispersionen auftreten. Die Anforderungen partikelbasierter Solarzellen konnten offengelegt werden, dadurch gelang die Herstellung einer Solarzelle mit einer Effizienz von 0.53%. Dieses Ergebnis stellt jedoch noch nicht das Optimum dar und lässt noch Möglichkeiten für Verbesserungen offen.

Development of a system measuring adhesion forces in powder collectives

Fine powders commonly have poor flowability and dispersibility due to interparticle adhesion that leads to formation of agglomerates. Knowing about adhesion in particle collectives is indispensable to gain a deeper fundamental understanding of particle behavior in powders. Especially in pharmaceutical industry a control of adhesion forces in powders is mandatory to improve the performance of inhalation products. Typically the size of inhalable particles is in the range of 1 - 5 µm. In this thesis, a new method was developed to measure adhesion forces of particles as an alternative to the established colloidal probe and centrifuge technique, which are both experimentally demanding, time consuming and of limited practical applicability. The new method is based on detachment of individual particles from a surface due to their inertia. The required acceleration in the order of 500 000 g is provided by a Hopkinson bar shock excitation system and measured via laser vibrometry. Particle detachment events are detected on-line by optical video microscopy. Subsequent automated data evaluation allows obtaining a statistical distribution of particle adhesion forces. To validate the new method, adhesion forces for ensembles of single polystyrene and silica microspheres on a polystyrene coated steel surface were measured under ambient conditions. It was possible to investigate more than 150 individual particles in one experiment and obtain adhesion values of particles in a diameter range of 3 - 13 µm. This enables a statistical evaluation while measuring effort and time are considerably lower compared to the established techniques. Measured adhesion forces of smaller particles agreed well with values from colloidal probe measurements and theoretical predictions. However, for the larger particles a stronger increase of adhesion with diameter was observed. This discrepancy might be induced by surface roughness and heterogeneity that influence small and large particles differently. By measuring adhesion forces of corrugated dextran particles with sizes down to 2 µm it was demonstrated that the Hopkinson bar method can be used to characterize more complex sample systems as well. Thus, the new device will be applicable to study a broad variety of different particle-surface combinations on a routine basis, including strongly cohesive powders like pharmaceutical drugs for inhalation.

Fast frontend electronics for high rate particle detectors

Future experiments in nuclear and particle physics are moving towards the high luminosity regime in order to access rare processes. In this framework, particle detectors require high rate capability together with excellent timing resolution for precise event reconstruction. In order to achieve this, the development of dedicated FrontEnd Electronics (FEE) for detectors has become increasingly challenging and expensive. Thus, a current trend in R&D is towards flexible FEE that can be easily adapted to a great variety of detectors, without impairing the required high performance. This thesis reports on a novel FEE for two different detector types: imaging Cherenkov counters and plastic scintillator arrays. The former requires high sensitivity and precision for detection of single photon signals, while the latter is characterized by slower and larger signals typical of scintillation processes. The FEE design was developed using high-bandwidth preamplifiers and fast discriminators which provide Time-over-Threshold (ToT). The use of discriminators allowed for low power consumption, minimal dead-times and self-triggering capabilities, all fundamental aspects for high rate applications. The output signals of the FEE are readout by a high precision TDC system based on FPGA. The performed full characterization of the analogue signals under realistic conditions proved that the ToT information can be used in a novel way for charge measurements or walk corrections, thus improving the obtainable timing resolution. Detailed laboratory investigations proved the feasibility of the ToT method. The full readout chain was investigated in test experiments at the Mainz Microtron: high counting rates per channel of several MHz were achieved, and a timing resolution of better than 100 ps after walk correction based on ToT was obtained. Ongoing applications to fast Time-of-Flight counters and future developments of FEE have been also recently investigated.

Microchannel heat exchangers: An attractive option for the regenerator of a mobile orc waste heat recovery system

The performance of microchannel heat exchangers was assessed in gas-to-liquid applications in the order of several tens of kWth . The technology is suitable for exhaust heat recovery systems based on organic Rankine cycle. In order to design a light and compact microchannel heat exchanger, an optimization process is developed. The model employed in the procedure is validated through computational fluid-dynamics analysis with commercial software. It is shown that conjugate effects have a significant impact on the heat transfer performance of the device.

Design of an indirectly fired gas turbine integrated with an organic rankine cycle unit for combined heat and power production

In the last years, the European countries have paid increasing attention to renewable sources and greenhouse emissions. The Council of the European Union and the European Parliament have established ambitious targets for the next years. In this scenario, biomass plays a prominent role since its life cycle produces a zero net carbon dioxide emission. Additionally, biomass can ensure plant operation continuity thanks to its availability and storage ability. Several conventional systems running on biomass are available at the moment. Most of them are performant either in the large-scale or in the small power range. The absence of an efficient system on the small-middle scale inspired this thesis project. The object is an innovative plant based on a wet indirectly fired gas turbine (WIFGT) integrated with an organic Rankine cycle (ORC) unit for combined heat and power production. The WIFGT is a performant system in the small-middle power range; the ORC cycle is capable of giving value to low-temperature heat sources. Their integration is investigated in this thesis with the aim of carrying out a preliminary design of the components. The targeted plant output is around 200 kW in order not to need a wide cultivation area and to avoid biomass shipping. Existing in-house simulation tools are used: They are adapted to this purpose. Firstly the WIFGT + ORC model is built; Zero-dimensional models of heat exchangers, compressor, turbines, furnace, dryer and pump are used. Different fluids are selected but toluene and benzene turn out to be the most suitable. In the indirectly fired gas turbine a pressure ratio around 4 leads to the highest efficiency. From the thermodynamic analysis the system shows an electric efficiency of 38%, outdoing other conventional plants in the same power range. The combined plant is designed to recover thermal energy: Water is used as coolant in the condenser. It is heated from 60°C up to 90°C, ensuring the possibility of space heating. Mono-dimensional models are used to design the heat exchange equipment. Different types of heat exchangers are chosen depending on the working temperature. A finned-plate heat exchanger is selected for the WIFGT heat transfer equipment due to the high temperature, oxidizing and corrosive environment. A once-through boiler with finned tubes is chosen to vaporize the organic fluid in the ORC. A plate heat exchanger is chosen for the condenser and recuperator. A quasi-monodimensional model for single-stage axial turbine is implemented to design both the WIFGT and the ORC turbine. The system simulation after the components design shows an electric efficiency around 34% with a decrease by 10% compared to the zero-dimensional analysis. The work exhibits the system potentiality compared to the existing plants from both technical and economic point of view.

Recent advances into understanding some aspects of the structure and function of mammalian and avian lungs

Recent findings are reported about certain aspects of the structure and function of the mammalian and avian lungs that include (a) the architecture of the air capillaries (ACs) and the blood capillaries (BCs); (b) the pulmonary blood capillary circulatory dynamics; (c) the adaptive molecular, cellular, biochemical, compositional, and developmental characteristics of the surfactant system; (d) the mechanisms of the translocation of fine and ultrafine particles across the airway epithelial barrier; and (e) the particle-cell interactions in the pulmonary airways. In the lung of the Muscovy duck Cairina moschata, at least, the ACs are rotund structures that are interconnected by narrow cylindrical sections, while the BCs comprise segments that are almost as long as they are wide. In contrast to the mammalian pulmonary BCs, which are highly compliant, those of birds practically behave like rigid tubes. Diving pressure has been a very powerful directional selection force that has influenced phenotypic changes in surfactant composition and function in lungs of marine mammals. After nanosized particulates are deposited on the respiratory tract of healthy human subjects, some reach organs such as the brain with potentially serious health implications. Finally, in the mammalian lung, dendritic cells of the pulmonary airways are powerful agents in engulfing deposited particles, and in birds, macrophages and erythrocytes are ardent phagocytizing cellular agents. The morphology of the lung that allows it to perform different functions-including gas exchange, ventilation of the lung by being compliant, defense, and secretion of important pharmacological factors-is reflected in its "compromise design."

Detection and identification of 700 drugs by multi-target screening with a 3200 Q TRAP LC-MS/MS system and library searching

The multi-target screening method described in this work allows the simultaneous detection and identification of 700 drugs and metabolites in biological fluids using a hybrid triple-quadrupole linear ion trap mass spectrometer in a single analytical run. After standardization of the method, the retention times of 700 compounds were determined and transitions for each compound were selected by a "scheduled" survey MRM scan, followed by an information-dependent acquisition using the sensitive enhanced product ion scan of a Q TRAP hybrid instrument. The identification of the compounds in the samples analyzed was accomplished by searching the tandem mass spectrometry (MS/MS) spectra against the library we developed, which contains electrospray ionization-MS/MS spectra of over 1,250 compounds. The multi-target screening method together with the library was included in a software program for routine screening and quantitation to achieve automated acquisition and library searching. With the help of this software application, the time for evaluation and interpretation of the results could be drastically reduced. This new multi-target screening method has been successfully applied for the analysis of postmortem and traffic offense samples as well as proficiency testing, and complements screening with immunoassays, gas chromatography-mass spectrometry, and liquid chromatography-diode-array detection. Other possible applications are analysis in clinical toxicology (for intoxication cases), in psychiatry (antidepressants and other psychoactive drugs), and in forensic toxicology (drugs and driving, workplace drug testing, oral fluid analysis, drug-facilitated sexual assault).

Spatial and functional relationships between air conduits and blood capillaries in the pulmonary gas exchange tissue of adult and developing chickens

The documented data regarding the three-dimensional structure of the air capillaries (ACs), the ultimate sites of gas exchange in the avian lung is contradictory. Further, the mode of gas exchange, described as cross-current has not been clearly elucidated. We studied the temporal and spatial arrangement of the terminal air conduits of the chicken lung and their relationship with the blood capillaries (BCs) in embryos as well as the definitive architecture in adults. Several visualization techniques that included corrosion casting, light microscopy as well as scanning and transmission electron microscopy were used. Two to six infundibulae extend from each atrium and give rise to numerous ACs that spread centrifugally. Majority of the ACs are tubular structures that give off branches, which anastomose with their neighboring cognates. Some ACs have globular shapes and a few are blind-ending tapering tubes. During inauguration, the luminal aspects of the ACs are characterized by numerous microvillus-like microplicae, which are formed during the complex processes of cell attenuation and canalization of the ACs. The parabronchial exchange BCs, initially inaugurated as disorganized meshworks, are reoriented via pillar formation to lie predominantly orthogonal to the long axes of the ACs. The remodeling of the retiform meshworks by intussusceptive angiogenesis essentially accomplishes a cross-current system at the gas exchange interface in the adults, where BCs form ring-like patterns around the ACs, thus establishing a cross-current system. Our findings clarify the mode of gas exchange in the parabronchial mantle and illuminate the basis for the functional efficiency of the avian lung.

An optimized in vitro model of the respiratory tract wall to study particle cell interactions

As a part of the respiratory tissue barrier, lung epithelial cells play an important role against the penetration of the body by inhaled particulate foreign materials. In most cell culture models, which are designed to study particle-cell interactions, the cells are immersed in medium. This does not reflect the physiological condition of lung epithelial cells which are exposed to air, separated from it only by a very thin liquid lining layer with a surfactant film at the air-liquid interface. In this study, A549 epithelial cells were grown on microporous membranes in a two chamber system. After the formation of a confluent monolayer the cells were exposed to air. The morphology of the cells and the expression of tight junction proteins were studied with confocal laser scanning and transmission electron microscopy. Air-exposed cells maintained monolayer structure for 2 days, expressed tight junctions and developed transepithelial electrical resistance. Surfactant was produced and released at the apical side of the air-exposed epithelial cells. In order to study particle-cell interactions fluorescent 1 microm polystyrene particles were sprayed over the epithelial surface. After 4 h, 8.8% of particles were found inside the epithelium. This fraction increased to 38% after 24 h. During all observations, particles were always found in the cells but never between them. In this study, we present an in vitro model of the respiratory tract wall consisting of air-exposed lung epithelial cells covered by a liquid lining layer with a surfactant film to study particle-cell interactions.

Changes in respiratory mechanics and gas exchange during the acute respiratory distress syndrome

BACKGROUND: The time course of impairment of respiratory mechanics and gas exchange in the acute respiratory distress syndrome (ARDS) remains poorly defined. We assessed the changes in respiratory mechanics and gas exchange during ARDS. We hypothesized that due to the changes in respiratory mechanics over time, ventilatory strategies based on rigid volume or pressure limits might fail to prevent overdistension throughout the disease process. METHODS: Seventeen severe ARDS patients {PaO2/FiO2 10.1 (9.2-14.3) kPa; 76 (69-107) mmHg [median (25th-75th percentiles)] and bilateral infiltrates} were studied during the acute, intermediate, and late stages of ARDS (at 1-3, 4-6 and 7 days after diagnosis). Severity of lung injury, gas exchange, and hemodynamics were assessed. Pressure-volume (PV) curves of the respiratory system were obtained, and upper and lower inflection points (UIP, LIP) and recruitment were estimated. RESULTS: (1) UIP decreased from early to established (intermediate and late) ARDS [30 (28-30) cmH2O, 27 (25-30) cmH2O and 25 (23-28) cmH2O (P=0.014)]; (2) oxygenation improved in survivors and in patients with non-pulmonary etiology in late ARDS, whereas all patients developed hypercapnia from early to established ARDS; and (3) dead-space ventilation and pulmonary shunt were larger in patients with pulmonary etiology during late ARDS. CONCLUSION: We found a decrease in UIP from acute to established ARDS. If applied to our data, the inspiratory pressure limit advocated by the ARDSnet (30 cmH2O) would produce ventilation over the UIP, with a consequent increased risk of overdistension in 12%, 43% and 65% of our patients during the acute, intermediate and late phases of ARDS, respectively. Lung protective strategies based on fixed tidal volume or pressure limits may thus not fully avoid the risk of lung overdistension throughout ARDS.

Population pharmacokinetics of sevoflurane in conjunction with the AnaConDa: toward target-controlled infusion of volatiles into the breathing system

BACKGROUND: The Anesthetic Conserving Device (AnaConDa) uncouples delivery of a volatile anesthetic (VA) from fresh gas flow (FGF) using a continuous infusion of liquid volatile into a modified heat-moisture exchanger capable of adsorbing VA during expiration and releasing adsorbed VA during inspiration. It combines the simplicity and responsiveness of high FGF with low agent expenditures. We performed in vitro characterization of the device before developing a population pharmacokinetic model for sevoflurane administration with the AnaConDa, and retrospectively testing its performance (internal validation). MATERIALS AND METHODS: Eighteen females and 20 males, aged 31-87, BMI 20-38, were included. The end-tidal concentrations were varied and recorded together with the VA infusion rates into the device, ventilation and demographic data. The concentration-time course of sevoflurane was described using linear differential equations, and the most suitable structural model and typical parameter values were identified. The individual pharmacokinetic parameters were obtained and tested for covariate relationships. Prediction errors were calculated. RESULTS: In vitro studies assessed the contribution of the device to the pharmacokinetic model. In vivo, the sevoflurane concentration-time courses on the patient side of the AnaConDa were adequately described with a two-compartment model. The population median absolute prediction error was 27% (interquartile range 13-45%). CONCLUSION: The predictive performance of the two-compartment model was similar to that of models accepted for TCI administration of intravenous anesthetics, supporting open-loop administration of sevoflurane with the AnaConDa. Further studies will focus on prospective testing and external validation of the model implemented in a target-controlled infusion device.