Acute effects of continuous rotational therapy on ventilation-perfusion inequality in lung injury
| Autor: | C Metz, A. Reber, Göran Hedenstierna, Thomas Bein, KW Jauch |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Adult
Male Artificial ventilation Rotation medicine.medical_treatment Hemodynamics Lung injury Critical Care and Intensive Care Medicine Ventilation/perfusion ratio Positive-Pressure Respiration Intensive care Supine Position Ventilation-Perfusion Ratio medicine Humans Prospective Studies Aged Aged 80 and over Respiratory Distress Syndrome Lung Multiple inert gas elimination technique business.industry Respiratory disease Middle Aged respiratory system medicine.disease Respiration Artificial respiratory tract diseases medicine.anatomical_structure Anesthesia Female business |
| Zdroj: | Intensive Care Medicine. 24:132-137 |
| ISSN: | 1432-1238 0342-4642 |
| DOI: | 10.1007/s001340050534 |
| Popis: | To investigate ventilation-perfusion (VA/Q) relationships, during continuous axial rotation and in the supine position, in patients with acute lung injury (ALI) using the multiple inert gas elimination technique.Prospective investigation.Eighteen-bed intensive care unit in a university hospital.Ten patients with ALI (PaO2/FIO2 ratio300 mm Hg) were mechanically ventilated in a pressure controlled mode and placed on a kinetic treatment table.Distributions of VA/Q were determined 1) during rotation (after a period of 20 min) and 2) after a resting period of 20 min in the supine position. During axial rotation, intrapulmonary shunt (19.1 +/- 15% of cardiac output) was significantly reduced in comparison with when in the supine position (23 +/- 14%, p0.05), areas with "low" VA/Q were not affected by the positioning maneuver. General VA/Q mismatch (logarithmic distribution of pulmonary blood flow) was decreased during rotation (0.87 +/- 0.37) in comparison with when the patient was in the supine position (0.93 +/- 0.37, p0.05). Arterial oxygenation was significantly improved during continuous rotation (PaO2/FIO2 = 217 +/- 137 mm Hg) as compared with in the supine position (PaO2/FIO2 = 174 +/- 82 mm Hg, p0.05). The positive response of the continuous rotation on arterial oxygenation was only demonstrated in patients with a Murray Score of 2.5 or less, indicating a "mild to moderate" lung injury, while in patients presenting with progressive ARDS (Murray Score2.5), the acute positive response was limited.Continuous axial rotation might be a method for an acute reduction of VA/Q mismatch in patients with mild to moderate ALI, but this technique is not effective in late or progressive ARDS. Further studies including a large data collection are needed. |
| Databáze: | OpenAIRE |
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