We concluded that the 10 cmH2O of PEEP attenuates the effects of PnP in respiratory mechanics, lowering R(RS), E(P), and E(RS). These effects may be useful in the ventilatory approach for patients experiencing a non-physiological increase in IAP owing to PnP in laparoscopic procedures.

may be related to high-dose use of norepinephrine. 1 Acute ischemic hepatitis ("shock liver") has been identified as a potential risk factor for limb ischemic necrosis or symmetrical peripheral gangrene. 2 The previous study shows that abnormal coagulation results, especially markedly elevated D-dimer and fibrin degradation product, are common in deaths with COVID-19. 3 Therefore, the occurrence of limb ischemic necrosis in COVID-19 patients should be monitored closely.

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The current methods of mechanical ventilation and pulmonary drug delivery do not account for the heterogeneity of acute respiratory distress syndrome (ARDS), or its dependence on gravity. The severe lung disease caused by SARS-CoV-2-2019 is one of the many causes of ARDS. SARS-CoV-2 has caused more than 2.7 million deaths world-wide and has challenged all therapeutic options for mechanical ventilation. Thus, new therapies are necessary to prevent deaths and long-term complications of severe lung diseases and prolonged mechanical ventilation. We have developed a novel device that allows selective lobe ventilation, selective lobe recruitment and provides a new platform for pulmonary drug delivery. A major advantage of separating lobes that are mechanically heterogeneous is to allow customization of ventilator parameters to match the needs of segments with similar compliance, for better overall ventilation perfusion relationship (V/Q) and prevention of ventilator induced lung injury (VILI) of more compliant lobes. This device accounts for lung heterogeneity and is a potential new therapy for acute lung injury by allowing selective lobe mechanical ventilation using two novel modes of mechanical ventilation (differential positive end-expiratory pressure and asynchronous ventilation) and two new modalities of alveolar recruitment (selective lobe recruitment and continuous positive airway pressure of lower lobes with continuous ventilation of upper lobes). We report initial experience with this novel device which includes a brief overview of device development, the initial in vitro, ex-vivo and in-vivo testing, layout future research, potential benefits, new therapies, and expected challenges prior to uniform implementation in clinical practice.