Positive end-expiratory pressure-induced functional recruitment in patients with acute respiratory distress syndrome
| Autor: | Roberto Fumagalli, Laurent Brochard, Jérôme Devaquet, Aissam Lyazidi, Fabiano Di Marco, Fabrice Galia, Nathalia Pinto da Costa |
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| Přispěvatelé: | Di Marco, F, Devaquet, J, Lyazidi, A, Galia, F, da Costa, N, Fumagalli, R, Brochard, L |
| Rok vydání: | 2009 |
| Předmět: |
Male
Resuscitation Critical Care Critical Illness Acute Lung Injury Critical Care and Intensive Care Medicine Risk Assessment Statistics Nonparametric Cohort Studies Hospitals University Positive-Pressure Respiration Oxygen Consumption Intensive care medicine Tidal Volume Humans Respiratory distress syndrome adult positive endexpiratory pressure Hospital Mortality Prospective Studies MED/41 - ANESTESIOLOGIA Tidal volume Positive end-expiratory pressure Probability Respiratory Distress Syndrome Lung Cross-Over Studies Respiratory distress business.industry Pulmonary Gas Exchange Respiratory disease respiratory system medicine.disease Prognosis Respiration Artificial Respiratory Function Tests Survival Rate Intensive Care Units medicine.anatomical_structure Treatment Outcome Anesthesia Female business Perfusion |
| Zdroj: | Critical care medicine. 38(1) |
| ISSN: | 1530-0293 |
| Popis: | OBJECTIVE: In acute respiratory distress syndrome, alveolar recruitment improves gas exchange only if perfusion of the recruited alveolar units is adequate. To evaluate functional recruitment induced by positive end-expiratory pressure, we assessed pulmonary conductance for gas exchange based on lung diffusion for carbon monoxide and its components, including pulmonary capillary blood volume. DESIGN: Prospective, randomized, crossover study. SETTING: Medical intensive care unit of a university hospital. PATIENTS: Sixteen patients with lung injury/acute respiratory distress syndrome as well as eight control patients under invasive ventilation and eight healthy volunteers. INTERVENTIONS: Mechanical ventilation with two levels of positive end-expiratory pressure (5 and 15 cm H2O). MEASUREMENTS AND MAIN RESULTS: Lung diffusion for carbon monoxide and lung volumes, arterial blood gas analysis, and pressure-volume curves. In patients with acute respiratory distress syndrome, high positive end-expiratory pressure induced a 23% mean lung diffusion for carbon monoxide increase (4.4 ± 1.7 mm Hg • min vs. 3.6 ± 1.4 mL • mm Hg • min). In control patients and in healthy volunteers, lung diffusion for carbon monoxide values were (median [interquartile range]) 5.5 [3.8-8.0] mm Hg • min and 19.6 [15.1-20.6] mL • mm Hg • min, respectively. Among patients with acute respiratory distress syndrome, eight showed a >20% lung diffusion for carbon monoxide increase (responders) when increasing positive end-expiratory pressure. In the other eight, lung diffusion for carbon monoxide decreased or showed a |
| Databáze: | OpenAIRE |
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