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Friday, 08/02/2013
Joan Daniel Martí successfully defended his doctoral thesis: “Efficacy and safety assessment of ventilatory strategies and respiratory therapy techniques to improve mucociliary clearance during invasive mechanical ventilation”
The public event was held last July 8th in the University of Barcelona, Faculty of Medicine
Joan Daniel Martí has been working as doctoral researcher at the Applied Research in Respiratory Diseases group led by Prof. Antoni Torres at the IDIBAPS. He qualified in Physiotherapy at the Universitat Ramon Llull of Barcelona and started his specialization in mechanical ventilation at the University of Medicine of Créteil (Paris) and later at the University of Barcelona through a Master on Respiratory Medicine. He takes part in the Animal Model research line and his research projects are based on finding new physiotherapy strategies to improve airway secretions clearance in critically patients and reduce the incidence of ventilator associated pneumonia (VAP). Results presented in his thesis were published on 2012 and 2013 in Critical Care Medicine. The public event took place on July 8th in the University of Barcelona, Faculty of Medicine, and the thesis tribunal comprised Dr. Antoni Artigas, from the Hospital Parc Taulí of Sabadell, Dra. Paula Ramírez, from the Hospital La Fe de Valencia, and Dr. Rik Gosselink, from the Faculty of Kinesiology and Rehabilitation Sciences at the University of Leuven (Belgium).
During mechanical ventilation, air flows may play a role in mucus transport via two-phase gas liquid flow. That is the reason why in the first study of his thesis Dr. Joan Daniel Martí evaluated effects of duty cycles and positive end-expiratory pressure on mucus clearance in pigs using mechanical ventilation, and assessed their safety. In this prospective randomized animal study with eight healthy pigs, pigs were intubated and on volume-control mechanical ventilation for up to 84 hrs in a surgical bed oriented 30 degrees in the reverse Trendelenburg position, as in the semirecumbent position. The work was published in Critical Care Medicine (40(3):895-902), and it concludes that mucus clearance is improved with prolongation of the duty cycle. However, in clinical practice, positive findings must be balanced against the potentially adverse hemodynamic and respiratory effects.
In a second study he investigated the effects of two different types of manual rib cage compression on expiratory flow and mucus clearance during prolonged mechanical ventilation in pigs. This prospective randomized animal study with nine healthy pigs was published in Critical Care Medicine (41(3):850-6). Pigs were tracheally intubated, sedated, paralyzed, and mechanically ventilated on a surgical bed in the anti-Trendelenburg position. The experiments were carried out at approximately 60 and 80 hrs from the beginning of mechanical ventilation. Two types of manual rib cage compressions were tested. Hard manual rib cage compression improved mucus clearance in animals positioned in the anti-Trendelenburg position, while soft manual rib cage compression was not effective and potentially unsafe.
Dr. Joan Daniel Martí brilliantly defended his doctoral thesis and obtained the best qualification, Excellent Cum Laude. The thesis was presented in English and raised interest among the thesis tribunal. The tribunal members also acknowledged the leadership of the thesis directors, Prof. Antoni Torres and Dr. Miquel Ferrer.