Optimizing mechanical ventilation, lung imaging and intrapulmonary drug delivery in operating room and intensive care unit patients

This thesis is a collection of investigations regarding the improvement of care in patients admitted to the intensive care unit or undergoing general anesthesia for surgery.
In the first part we focus on the effects of specific mechanical ventilation settings on clinical outcome and the development of ventilator-induced lung injury. This part reports the results of two clinical studies on specific sub-populations: obese and cardiac surgery patients. The focus is then shifted to mechanical ventilation in the critical care setting, with one experimental study in a model of ARDS in large animals, and a meta-analysis of randomized clinical studies on the role of PEEP.
In the second part of the thesis, after an overview of the currently available imaging techniques for the lung in mechanically ventilation patients, we present the results of four pilot studies. Two studies focus on the optimization of computed tomography to quantify lung aeration, one proposes the quantification of lung edema with lung ultrasound image analysis, one introduces a method to assess lung aeration with magnetic resonance imaging.
In the third part of the thesis we focus on nebulization in patients receiving invasive or non-invasive respiratory assistance. We present the results of two bench-top studies and a clinical investigation.