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
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