Recruitment and derecruitment during acute respiratory failure: an experimental study
| Autor: | John J. Marini, Paolo Pelosi, Luciano Gattinoni, Pietro Caironi, S Losappio, Giuditta Eccher, Andrew McKIBBEN, Alex Adams, Mari Goldner |
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| Rok vydání: | 2001 |
| Předmět: |
Pulmonary and Respiratory Medicine
Artificial ventilation Male medicine.medical_treatment Lung injury Critical Care and Intensive Care Medicine Positive-Pressure Respiration Dogs Respiration medicine Animals Tomography Tidal volume Mechanical ventilation Pulmonary Gas Exchange Respiratory Insufficiency Oleic Acid X-Ray Computed Artificial Female biology business.industry Fissipedia Respiratory disease respiratory system biology.organism_classification medicine.disease Respiration Artificial respiratory tract diseases Respiratory failure Anesthesia business Tomography X-Ray Computed |
| Zdroj: | American journal of respiratory and critical care medicine. 164(1) |
| ISSN: | 1073-449X |
| Popis: | We aimed to elucidate the relationships between pleural (Ppl), esophageal (Pes), and superimposed gravitational pressures in acute lung injury, and to understand the mechanisms of recruitment and derecruitment. In six dogs with oleic acid respiratory failure, we measured Pes and Ppl in the uppermost, middle, and most dependent lung regions. Each dog was studied at positive end-expiratory pressure (PEEP) of 5 and 15 cm H2O and three levels of tidal volume (VT; low, medium, and high). For each PEEP-VT combination, we obtained a computed tomographic (CT) scan at end-inspiration and end-expiration. The variations of Ppl and Pes pressures were correlated (r = 0.86 +/- 0.07, p0.0001), as was the vertical gradient of transpulmonary (PL) and superimposed pressure (r = 0.92, p0.0001). Recruitment proceeded continuously along the entire volume-pressure curve. Estimated threshold opening pressures were normally distributed (mode = 20 to 25 cm H2O). The amount of end-expiratory collapse at the same PEEP and PL was significantly lower when ventilation was performed at high VT. End-inspiratory and end-expiratory collapse were highly correlated (r = 0.86, p0.0001), suggesting that as more tissue is recruited at end-inspiration, more remains recruited at end-expiration. When superimposed pressure exceeded applied airway pressure (Paw), collapse significantly increased. |
| Databáze: | OpenAIRE |
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