PEEP titration in moderate to severe ARDS: plateau versus transpulmonary pressure
| Autor: | Tahar Saghi, Alexandre Ouattara, Bruno Fontaine, Tan Bounkim, David Tran-Van, Ariane Gentile, Marie Bergez, Nicolas Fritsch, Hadrien Rozé, Philippe Labadie |
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| Rok vydání: | 2019 |
| Předmět: |
Moderate to severe
ARDS medicine.medical_specialty Monitoring Distension Critical Care and Intensive Care Medicine 03 medical and health sciences Plateau pressure 0302 clinical medicine PEEP titration Internal medicine Medicine Lung volumes Lung protection business.industry Research lcsh:Medical emergencies. Critical care. Intensive care. First aid 030208 emergency & critical care medicine lcsh:RC86-88.9 Oxygenation respiratory system medicine.disease respiratory tract diseases 030228 respiratory system Cardiology Transpulmonary pressure business circulatory and respiratory physiology |
| Zdroj: | Annals of Intensive Care Annals of Intensive Care, Vol 9, Iss 1, Pp 1-8 (2019) |
| ISSN: | 2110-5820 |
| Popis: | Background Although lung protection with low tidal volume and limited plateau pressure (P plat) improves survival in acute respiratory distress syndrome patients (ARDS), the best way to set positive end-expiratory pressure (PEEP) is still debated. Methods This study aimed to compare two strategies using individual PEEP based on a maximum P plat (28–30 cmH2O, the Express group) or on keeping end-expiratory transpulmonary pressure positive (0–5 cmH2O, P Lexpi group). We estimated alveolar recruitment (Vrec), end-expiratory lung volume and alveolar distension based on elastance-related end-inspiratory transpulmonary pressure (P L,EL). Results Nineteen patients with moderate to severe ARDS (PaO2/FiO2 25 cmH2O. Conclusions There is a great heterogeneity of P Lexpi when P plat is used to titrate PEEP but with limited risk of over-distension. A PEEP titration for a moderate positive level of P Lexpi might slightly improve alveolar recruitment and oxygenation but increases the risk of over-distension in one-third of patients. |
| Databáze: | OpenAIRE |
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