From the laboratory to the bedside: a multidisciplinary program to reduce the impact of cardio-respiratory diseases /
Adult Anesthesia and Intensive Care

Research program on patient-base therapy for the critically ill patients
Focus of the research activity is the definition of patient-based therapies and life supports for critical patients, especially for patients affected by acute respiratory failure and sepsis. Patient phenotypes, microcirculation function, the interactions between patient and life supports and between native and artificial organ will be studied.

Research program on myocardial ischemia, cardiac arrest and cardiopulmonary resuscitation
Research activities include experimental studies and clinical trials whose purpose is to:

• Assess the epidemiology of the pathology
• Study the pathophysiological mechanisms of heart, lung, and brain injury from cardiac arrest
• Study and test new interventions to improve cardiopulmonary resuscitation and defibrillation
• Evaluate new post resuscitation therapeutic strategies to improve survival and neurological and functional outcome
• Identify and study new circulating markers:
  • analyze epidemiologic data and short- and long-term outcomes
  • collect and analyze data on rescue interventions by the community emergency system
  • design and conduct observational and interventional studies, both pharmacological and on medical devices, on prehospital management

Research program on respiratory physiology
Research activities include experimental studies and clinical trials on:

• Physiological research on the mechanisms of increased respiratory drive and on lung injury caused by ventilation-perfusion mismatch in patients admitted to the intensive care unit with hypoxemic acute respiratory failure
• Experimental research on mechanisms of acute lung injury associated with ventilation-perfusion mismatch.

Research program on monitoring and management of acute respiratory failure
Research activities include experimental studies and clinical trials on:

• Advanced respiratory monitoring (respiratory drive, inspiratory effort, diaphragmatic electromyography, functional respiratory muscle assessment)
• Setting invasive and noninvasive mechanical ventilation
• Pathophysiology and management of extracorporeal respiratory support (ECMO)
• Epidemiology, etiology and impact on outcome of nosocomial infections in critically ill patients

Research program on perioperative management of solid organ transplantation
The focus of the research program is the optimization of intraoperative and postoperative management of patients undergoing solid organ transplantation, with particular attention to lung and liver transplant. The aim of the projects is the improvement of the management of these patients in ICU: optimization of mechanical ventilation, prevention and treatment of primary graft dysfunction; hemodynamic optimization and prevention of right ventricular dysfunction; and optimization and prevention of postoperative renal failure.

Research program on coagulation problems of critically ill patients
The objective of this research is to study the coagulation problems of critically ill patients using viscoelastic point-of-care tests of coagulation. This technology has been extensively used in recent years to guide the administration of blood products in critically ill patient in case of severe bleeding, to identify patients at thromboembolic risk, and to allow titration of anticoagulants during extracorporeal circulation for acute respiratory and cardiac failure. Our research is currently focused on the development of algorithms for coagulation monitoring, definition of normal ranges for special critical patient populations, and the study of hypo-fibrinolysis in patients with sepsis and septic shock. Thrombotic complications related to vascular accesses will also be evaluated.

Research program on organ supports
Focus of the research activity is the development of techniques and technologies that can improve both the support of the critically ill patients with organ failure and the ex-situ support of organs harvested for transplantation. Research activities, when applicable, will start with in-silico studies followed by in-vitro, ex-situ, experimental and clinical studies.