Marini, John J., MD uri icon
Director of Physiological and Translational Research, Regions Hospital
About me

HealthPartners Medical Group title: Physician in pulmonary medicine, Regions Hospital

Education and training: MD, Johns Hopkins University School of Medicine; residency in internal medicine and fellowship in pulmonary medicine, University of Washington.

Overview/research interests: Cardiopulmonary physiology and management of acute respiratory failure, with an emphasis on patient-ventilator interactions occurring in that clinical setting. In most of his research, he has positioned himself at the interface between basic physiology and clinical medicine to develop insights into advancing clinical practice.

Current research activities and funding: Collaborating with colleagues who are well-versed in advanced imaging and biological sciences to explore questions of mutual interest.

 
Publications
selected publications
Journal Article
  • A more gradual positive end-expiratory pressure increase reduces lung damage and improves cardiac function in experimental acute respiratory distress syndrome. 
    Journal of applied physiology (Bethesda, Md.. 2022
  • Can we always trust the wisdom of the body?. 
    Critical Care Medicine. 2022
  • Mechanisms of oxygenation responses to proning and recruitment in COVID-19 pneumonia. 
    Intensive Care Medicine. 2022
  • Reliable estimates of power delivery during mechanical ventilation utilizing easily obtained bedside parameters. 
    Respiratory Care. 2022
  • Dorsal push and abdominal binding improve respiratory compliance and driving pressure in proned coronavirus disease 2019 acute respiratory distress syndrome. 
    Critical care explorations. 2021
  • Elastic power of mechanical ventilation in morbid obesity and severe hypoxemia. 
    Respiratory Care. 2021
  • Intra-cycle power: is the flow profile a neglected component of lung protection?. 
    Intensive Care Medicine. 2021
  • Intracycle power and ventilation mode as potential contributors to ventilator-induced lung injury. 
    Intensive care medicine experimental. 2021
  • Paradoxically improved respiratory compliance with abdominal compression in COVID-19 ARDS. 
    Chest. 2021
  • Prevalence and outcome of silent hypoxemia in COVID-19. 
    Minerva Anestesiologica. 2021
  • Role of total lung stress on the progression of early COVID-19 pneumonia. 
    Intensive Care Medicine. 2021
  • The impact of fluid status and decremental PEEP strategy on cardiac function and lung and kidney damage in mild-moderate experimental acute respiratory distress syndrome. 
    Respiratory Research. 2021
  • "Less is More" in mechanical ventilation. 
    Intensive Care Medicine. 2020
  • Does iso-mechanical power lead to iso-lung damage: an experimental study in a porcine model. 
    Anesthesiology. 2020
  • Elastic power but not driving power is the key promoter of ventilator-induced lung injury in experimental acute respiratory distress syndrome. 
    Critical Care (London, England). 2020
  • Estimating the damaging power of high-stress ventilation. 
    Respiratory Care. 2020
  • Management of COVID-19 respiratory distress. 
    JAMA. 2020
  • Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study. 
    Intensive Care Medicine. 2020
  • Time course of evolving ventilator-induced lung injury: the "shrinking baby lung". 
    Critical Care Medicine. 2020
  • What have we learned from animal models of ventilator-induced lung injury?. 
    Intensive Care Medicine. 2020
  • Driving pressure: defining the range. 
    Respiratory Care. 2019
  • Gradually increasing tidal volume may mitigate experimental lung injury in rats. 
    Anesthesiology. 2019
  • Positive end-expiratory pressure and mechanical power. 
    Anesthesiology. 2019
  • Understanding lactatemia in human sepsis. Potential impact for early management. 
    American Journal of Respiratory and Critical Care Medicine. 2019
  • Conditional hemodynamic tolerance to decremental recruitment of the "open lung". 
    Critical Care Medicine. 2018
  • Energetics and the root mechanical cause for ventilator-induced lung injury. 
    Anesthesiology. 2018
  • PEEP titration: the effect of prone position and abdominal pressure in an ARDS model. 
    Intensive care medicine experimental. 2018
  • Positional effects on the distributions of ventilation and end-expiratory gas volume in the asymmetric chest-a quantitative lung computed tomographic analysis. 
    Intensive care medicine experimental. 2018
  • Protecting the ventilated lung: vascular surge and deflation energetics. 
    American Journal of Respiratory and Critical Care Medicine. 2018
  • Evidence or belief-based medicine? Ten doubts. 
    Intensive Care Medicine. 2017
  • Reliability of transpulmonary pressure-time curve profile to identify tidal recruitment/hyperinflation in experimental unilateral pleural effusion. 
    Journal of Clinical Monitoring and Computing. 2017
  • Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. 
    Intensive Care Medicine. 2017
  • Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. 
    Critical Care Medicine. 2017
  • Fast versus slow recruitment maneuver at different degrees of acute lung inflammation induced by experimental sepsis. 
    Anesthesia and Analgesia. 2016
  • Strain rate and cycling frequency-The "dynamic duo" of injurious tidal stress. 
    Critical Care Medicine. 2016
  • The effect of compartmental asymmetry on the monitoring of pulmonary mechanics and lung volumes. 
    Respiratory Care. 2016
  • Biological impact of transpulmonary driving pressure in experimental acute respiratory distress syndrome. 
    Anesthesiology. 2015
  • Critical care evidence--new directions. 
    JAMA. 2015
  • Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study. 
    Critical Care (London, England). 2015
  • Impact of chest wall modifications and lung injury on the correspondence between airway and transpulmonary driving pressures. 
    Critical Care Medicine. 2015
  • The top attributes of excellence of intensive care physicians. 
    Intensive Care Medicine. 2015
  • Development of a lethal, closed-abdomen, arterial hemorrhage model in noncoagulopathic swine. 
    Journal of Surgical Research. 2014
  • Drainage of pleural effusion in mechanically ventilated patients: time to measure chest wall compliance?. 
    Journal of Critical Care. 2014
  • Positional effects on lung volumes and transpulmonary pressure during unilateral mechanical asymmetry. 
    Minnesota Medicine. 2014
  • Self-expanding foam for prehospital treatment of intra-abdominal hemorrhage: 28-day survival and safety. 
    The journal of trauma and acute care surgery. 2014
  • Self-expanding foam for prehospital treatment of severe intra-abdominal hemorrhage: dose finding study. 
    The journal of trauma and acute care surgery. 2014
  • Self-expanding foam improves survival following a lethal, exsanguinating iliac artery injury. 
    The journal of trauma and acute care surgery. 2014
  • Unilateral mechanical asymmetry. Positional effects on lung volumes and transpulmonary pressure. 
    Intensive care medicine experimental. 2014
  • Experimental intra-abdominal hypertension influences airway pressure limits for lung protective mechanical ventilation. 
    The journal of trauma and acute care surgery. 2013
  • Recruitment maneuvers modulate epithelial and endothelial cell response according to acute lung injury etiology. 
    Critical Care Medicine. 2013
  • Under pressure. 
    Annals of the American Thoracic Society. 2013
  • Value and limitations of transpulmonary pressure calculations during intra-abdominal hypertension. 
    Critical Care Medicine. 2013
  • Ventilator-associated problems related to obstructive lung disease. 
    Respiratory Care. 2013
  • Experimental intra-abdominal hypertension attenuates the benefit of positive end-expiratory pressure in ventilating effusion-compressed lungs*. 
    Critical Care Medicine. 2012
  • Dynamic hyperinflation and auto-positive end-expiratory pressure: lessons learned over 30 years. 
    American Journal of Respiratory and Critical Care Medicine. 2011
  • Impact of pressure profile and duration of recruitment maneuvers on morphofunctional and biochemical variables in experimental lung injury. 
    Critical Care Medicine. 2011
  • Non-pulmonary factors strongly influence the stress index. 
    Intensive Care Medicine. 2011
  • Pleural effusion complicates monitoring of respiratory mechanics. 
    Critical Care Medicine. 2011
  • Agreement between functional residual capacity estimated via automated gas dilution versus via computed tomography in a pleural effusion model. 
    Respiratory Care. 2010
  • Can we prevent the spread of focal lung inflammation?. 
    Critical Care Medicine. 2010
  • Cardiovascular and metabolic effects of high-dose insulin in a porcine septic shock model. 
    Academic Emergency Medicine. 2010
  • Prone positioning for ARDS: defining the target. 
    Intensive Care Medicine. 2010
  • Safer ventilation of the injured lung: one step closer. 
    Critical Care (London, England). 2010
  • Thermal therapeutics: the importance of good timing. 
    Anesthesia and Analgesia. 2010
  • Thirty years of critical care medicine. 
    Critical Care (London, England). 2010
  • Acoustic monitoring--super sonics?. 
    Critical Care (London, England). 2009
  • Acute coronary thrombosis in a patient with septic shock without any evidence of disseminated intravascular coagulation. 
    BMJ Case Reports. 2009
  • Airway pressure release ventilation. 
    Journal of burn care & research. 2009
  • High dose insulin in toxic cardiogenic shock. 
    Clinical Toxicology (Philadelphia, Pa.). 2009
  • Semi-quantitative tracking of intra-airway fluids by computed tomography. 
    Clinical Physiology and Functional Imaging. 2009
  • Cigarettes-induced acute eosinophilic pneumonia: a case report
    2008
  • Do airway secretions play an underappreciated role in acute respiratory distress syndrome?. 
    Current Opinion in Critical Care. 2008
  • How best to recruit the injured lung?. 
    Critical Care (London, England). 2008
  • Lung injury--settle for a sketch or design a blueprint?. 
    Critical Care Medicine. 2008
  • Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. 
    American Journal of Respiratory and Critical Care Medicine. 2008
  • Meta-analysis: convenient assumptions and inconvenient truth. 
    Critical Care Medicine. 2008
  • Propagation prevention: a complementary mechanism for "lung protective" ventilation in acute respiratory distress syndrome. 
    Critical Care Medicine. 2008
  • Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. 
    Critical Care Medicine. 2008
  • Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. 
    Intensive Care Medicine. 2008
  • The pulmonary artery catheter: in medio virtus. 
    Critical Care Medicine. 2008
  • Ventilation patterns influence airway secretion movement. 
    Respiratory Care. 2008
  • The "open lung" compromise. 
    Intensive Care Medicine. 2007
  • Time course of physiologic variables in response to ventilator-induced lung injury. 
    Respiratory Care. 2007
  • A proposed curvilinearity index for quantifying airflow obstruction. 
    Respiratory Care. 2006
  • Limitations of clinical trials in acute lung injury and acute respiratory distress syndrome. 
    Current Opinion in Critical Care. 2006
  • Advances in the understanding of acute respiratory distress syndrome: summarizing a decade of progress. 
    Current Opinion in Critical Care. 2004
  • Effects of ventilatory pattern on experimental lung injury caused by high airway pressure. 
    Critical Care Medicine. 2004
  • Intercomparison of recruitment maneuver efficacy in three models of acute lung injury. 
    Critical Care Medicine. 2004
  • Partitioning the work-sparing effects of partial ventilatory support in airflow obstruction. 
    Critical Care (London, England). 2004
  • Reluctant horses at the digital river. 
    Critical Care (London, England). 2004
  • Transient hemodynamic effects of recruitment maneuvers in three experimental models of acute lung injury. 
    Critical Care Medicine. 2004
  • Ventilatory management of acute respiratory distress syndrome: a consensus of two. 
    Critical Care Medicine. 2004
  • Bench-to-bedside review: microvascular and airspace linkage in ventilator-induced lung injury. 
    Critical Care (London, England). 2003
  • Distal projection of insufflated gas during tracheal gas insufflation. 
    Journal of applied physiology (Bethesda, Md.. 2002
  • Oscillations and noise: inherent instability of pressure support ventilation?. 
    American Journal of Respiratory and Critical Care Medicine. 2002
  • Pulmonary microvascular fracture in a patient with acute respiratory distress syndrome. 
    Critical Care Medicine. 2002
  • Tracheal gas insufflation during late exhalation efficiently reduces PaCO(2) in experimental acute lung injury. 
    Intensive Care Medicine. 2002
  • Ventilation of patients with asthma and chronic obstructive pulmonary disease. 
    Current Opinion in Critical Care. 2002
  • Dynamic behavior during noninvasive ventilation: chaotic support?. 
    American Journal of Respiratory and Critical Care Medicine. 2001
  • Relative roles of vascular and airspace pressures in ventilator-induced lung injury. 
    Critical Care Medicine. 2001
  • Static and dynamic pressure-volume curves reflect different aspects of respiratory system mechanics in experimental acute respiratory distress syndrome. 
    Respiratory Care. 2001
  • Prone positioning attenuates and redistributes ventilator-induced lung injury in dogs. 
    Critical Care Medicine. 2000
  • Recruitment maneuvers in three experimental models of acute lung injury. Effect on lung volume and gas exchange. 
    American Journal of Respiratory and Critical Care Medicine. 2000
    • Editorial Article
  • Prone position and COVID-19: mechanisms and effects [editorial]. 
    Critical Care Medicine.  50. 2022
  • "Established" respiratory treatment in acute respiratory distress syndrome: scientific rigor or a square peg in a round hole [editorial]?. 
    American Journal of Respiratory and Critical Care Medicine.  203. 2021
  • COVID-19 and ARDS: the baby lung size matters [editorial]. 
    Intensive Care Medicine.  47. 2021
  • Complexity and unanswered questions in the pathophysiology of COVID-19 ARDS [editorial]. 
    Intensive Care Medicine.  47. 2021
  • Conceptual simplicity in pursuit of precision [editorial]. 
    Intensive Care Medicine.  47. 2021
  • Isn't it time to abandon ARDS? The COVID-19 lesson [editorial]. 
    Critical Care (London, England).  25. 2021
  • Pathophysiology of COVID-19-associated acute respiratory distress syndrome [editorial]. 
    The Lancet. Respiratory medicine.  9. 2021
  • Reply to Tobin: Respiratory drive measurements do not signify conjectural patient self-inflicted lung injury [editorial]. 
    American Journal of Respiratory and Critical Care Medicine.  203. 2021
  • Smoothing the edges of lung protection [editorial]. 
    American Journal of Respiratory and Critical Care Medicine.  203. 2021
  • The 4DPRR Index and mechanical power: a step ahead or four steps backward [editorial]?. 
    American Journal of Respiratory and Critical Care Medicine.  204. 2021
  • COVID-19 phenotypes: leading or misleading [editorial]?. 
    European Respiratory Journal.  56. 2020
  • COVID-19: scientific reasoning, pragmatism and emotional bias [editorial]. 
    Annals of intensive care.  10. 2020
  • Dealing with the CARDS of COVID-19 [editorial]. 
    Critical Care Medicine.  48. 2020
  • Finding best PEEP: a little at a time [editorial]. 
    Respiratory Care.  65. 2020
  • Hysteresis as an indicator of recruitment and ventilator-induced lung injury risk [editorial]. 
    Critical Care Medicine.  48. 2020
  • Integrating the evidence: confronting the COVID-19 elephant [editorial]. 
    Intensive Care Medicine.  46. 2020
  • Recruiting the acutely injured lung: how and why [editorial]?. 
    American Journal of Respiratory and Critical Care Medicine.  201. 2020
  • Spontaneous breathing, transpulmonary pressure and mathematical trickery [editorial]. 
    Annals of intensive care.  10. 2020
  • The baby lung and the COVID-19 era [editorial]. 
    Intensive Care Medicine.  46. 2020
  • The respiratory drive: an overlooked tile of COVID-19 pathophysiology [editorial]. 
    American Journal of Respiratory and Critical Care Medicine.  202. 2020
  • Which component of mechanical power is most important in causing VILI [editorial]?. 
    Critical Care (London, England).  24. 2020
  • The tidal volume fix [editorial]?. 
    Journal of Thoracic Disease.  11. 2019
  • Conditional value of raising positive end-expiratory pressure to counter vigorous breathing efforts in injured lungs [editorial]. 
    American Journal of Respiratory and Critical Care Medicine.  197. 2018
  • Do trials that report a neutral or negative treatment effect improve the care of critically ill patients? No [editorial]. 
    Intensive Care Medicine.  44. 2018
  • Firmer footing for ventilating and monitoring the injured lung [editorial]. 
    Journal of Thoracic Disease.  10. 2018
  • Should we titrate positive end-expiratory pressure based on an end-expiratory transpulmonary pressure [editorial]?. 
    Annals of translational medicine.  6. 2018
  • Time to rethink the approach to treating acute respiratory distress syndrome [editorial]. 
    JAMA.  319. 2018
  • Volutrauma and atelectrauma: which is worse [editorial]?. 
    Critical Care (London, England).  22. 2018
  • Clinical deployment of the esophageal balloon catheter-making the case [editorial]. 
    Critical Care Medicine.  45. 2017
  • Transpulmonary pressure meaning: Babel or conceptual evolution [editorial]?. 
    American Journal of Respiratory and Critical Care Medicine.  195. 2017
  • Dynamic predictors of VILI risk: beyond the driving pressure [editorial]. 
    Intensive Care Medicine.  42. 2016
  • Should we embrace the "open lung" approach [editorial]?. 
    Critical Care Medicine.  44. 2016
  • Does high-pressure, high-frequency oscillation shake the foundations of lung protection [editorial]?. 
    Intensive Care Medicine.  41. 2015
  • Prone positioning and neuromuscular blocking agents are part of standard care in severe ARDS patients: we are not sure [editorial]. 
    Intensive Care Medicine.  41. 2015
  • Introduction (foreword) to the issue. Heart and lung monitoring [editorial]. 
    Current Opinion in Critical Care.  20. 2014
  • Mid-frequency ventilation: a viable option for lung protection [editorial]?. 
    Respiratory Care.  59. 2014
  • Spontaneous breathing, extrapulmonary CO(2) removal, and ventilator-induced lung injury risk: less power to the people [editorial]?. 
    Critical Care Medicine.  42. 2014
  • Lower tidal volumes for everyone: principle or prescription [editorial]?. 
    Intensive Care Medicine.  39. 2013
  • Monitoring breathing effort: a work in progress [editorial]. 
    Critical Care Medicine.  41. 2013
  • Position, positive end-expiratory pressure, and obstructive obesity [editorial]. 
    Critical Care Medicine.  41. 2013
  • Too much for too long-wrong targets, wrong timing [editorial]?. 
    Critical Care Medicine.  41. 2013
  • Transpulmonary pressure as a surrogate of plateau pressure for lung protective strategy: not perfect but more physiologic [editorial]. 
    Intensive Care Medicine.  38. 2012
  • Does positive end-expiratory pressure improve CO(2) exchange in controlled ventilation of acute airflow obstruction [editorial]?. 
    Critical Care Medicine.  39. 2011
  • Point: Is pressure assist-control preferred over volume assist-control mode for lung protective ventilation in patients with ARDS? Yes [editorial]. 
    Chest.  140. 2011
  • Recruitment by sustained inflation: time for a change [editorial]. 
    Intensive Care Medicine.  37. 2011
  • Risk factors associated with early reintubation in trauma patients: a prospective observational study [invited editorial]. 
    Journal of Trauma.  71. 2011
    • Chapter
  • Ventilatory management of obstructive airway disease. 
    Critical care medicine: principles of diagnosis and management in the adult. 2014
  • Position and the compromised respiratory system. 
    Annual update in intensive care and emergency medicine. 2012
    • Conference Poster
  • Experimental intra-abdominal pressure symmetrically influences bladder pressure and airway plateau pressure [poster]
    2012
    • Review
  • COVID-19 pneumonia: pathophysiology and management [review]. 
    European Respiratory Review: An Official Journal of the European Respiratory Society. 2021
  • Improving lung compliance by external compression of the chest wall [review]. 
    Critical Care (London, England). 2021
  • Personalized mechanical ventilation in acute respiratory distress syndrome [review]. 
    Critical Care (London, England). 2021
  • Extracorporeal membrane oxygenation for respiratory failure [review]. 
    Anesthesiology. 2020
  • Prone position in ARDS patients: why, when, how and for whom [review]. 
    Intensive Care Medicine. 2020
  • Static and dynamic contributors to ventilator-induced lung injury in clinical practice. Pressure, energy, and power [review]. 
    American Journal of Respiratory and Critical Care Medicine. 2020
  • Acute lobar atelectasis [review]. 
    Chest. 2019
  • Evolving concepts for safer ventilation [review]. 
    Critical Care (London, England). 2019
  • Dissipation of energy during the respiratory cycle: conditional importance of ergotrauma to structural lung damage [review]. 
    Current Opinion in Critical Care. 2018
  • Physiology-guided management of hemodynamics in acute respiratory distress syndrome [review]. 
    Annals of translational medicine. 2018
  • Management of critical burn injuries: recent developments [review]
    2017
  • Respiratory support in patients with acute respiratory distress syndrome: an expert opinion [review]. 
    Critical Care (London, England). 2017
  • Seven unconfirmed ideas to improve future ICU practice [review]. 
    Critical Care (London, England). 2017
  • The future of mechanical ventilation: lessons from the present and the past [review]. 
    Critical Care (London, England). 2017
  • The intensive care medicine research agenda for airways, invasive and noninvasive mechanical ventilation [review]. 
    Intensive Care Medicine. 2017
  • Time-sensitive therapeutics [review]. 
    Critical Care (London, England). 2017
  • Excellence in intensive care medicine [review]. 
    Critical Care Medicine. 2016
  • Experts' opinion on management of hemodynamics in ARDS patients: focus on the effects of mechanical ventilation [review]. 
    Intensive Care Medicine. 2016
  • Is automated weaning superior to manual spontaneous breathing trials [review]?. 
    Respiratory Care. 2016
  • Should early prone positioning be a standard of care in ARDS with refractory hypoxemia [review]?. 
    Respiratory Care. 2016
  • The "baby lung" became an adult [review]. 
    Intensive Care Medicine. 2016
  • Lung recruitment in acute respiratory distress syndrome: what is the best strategy [review]?. 
    Current Opinion in Critical Care. 2014
  • Mechanical ventilation: past lessons and the near future [review]. 
    Critical Care (London, England). 2013
  • Our favorite unproven ideas for future critical care [review]. 
    Critical Care (London, England). 2013
  • Prone position in acute respiratory distress syndrome. Rationale, indications, and limits [review]. 
    American Journal of Respiratory and Critical Care Medicine. 2013
  • Two steps forward in bedside monitoring of lung mechanics: transpulmonary pressure and lung volume [review]. 
    Critical Care (London, England). 2013
  • Unproven clinical evidence in mechanical ventilation [review]. 
    Current Opinion in Critical Care. 2012
  • Update: adjuncts to mechanical ventilation [review]. 
    Current Opinion in Anaesthesiology. 2012
  • Spontaneously regulated vs. controlled ventilation of acute lung injury/acute respiratory distress syndrome [review]. 
    Current Opinion in Critical Care. 2011
    • Abstract
  • How does IAP affect esophageal pressure [abstract]?. 
    American Journal of Respiratory and Critical Care Medicine. 2013
  • Fowler's position reduces effusion-caused compressive lung stress and increases functional residual capacity [abstract]. 
    American Journal of Respiratory and Critical Care Medicine. 2012
  • Intra-abdominal pressure transmission to the thorax is predominantly at end-inspiration [abstract]. 
    American Journal of Respiratory and Critical Care Medicine. 2012
  • Tidal coefficient of variation as a predictor of weaning success [abstract]. 
    American Journal of Respiratory and Critical Care Medicine. 2012
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