Document Detail

ARDSNet lower tidal volume ventilatory strategy may generate intrinsic positive end-expiratory pressure in patients with acute respiratory distress syndrome.
MedLine Citation:
PMID:  11991877     Owner:  NLM     Status:  MEDLINE    
The ARDSNet trial revealed that the use of a smaller tidal volume (VT) reduced mortality by 22%. However, three earlier studies that lowered VT did not find a decrease in mortality. We tested the hypothesis that the increased respiratory rate used in the ARDSNet lower VT strategy might have led to intrinsic positive end-expiratory pressure (PEEP(i)), raising total PEEP (PEEP(total)). Ten patients with acute respiratory distress syndrome (ARDS) were ventilated using the ARDSNet lower VT protocol. Respiratory rate was then reduced (10-15 breaths/minute) to obtain a VT of 12 ml/kg (ARDSNet traditional VT). PEEP on the ventilator (PEEP(nominal): 10.1 +/- 0.7 cm H2O), FIO2 (0.7 +/- 0.1), and minute ventilation (VE: 12.4 +/- 1.7 L/minute) were set using the ARDSNet protocol and maintained constant during the two ventilatory strategies. Values of airway pressure at end-expiration of a regular breath (PEEP(external)) and 3-5 seconds after the onset of an end-expiratory occlusion (PEEP(total)) were measured. PEEP(i) was calculated by subtracting PEEP(external) from PEEP(total). PEEP(total) and PEEP(i) were, respectively, 16.3 +/- 2.9 and 5.8 +/- 3.0 cm H2O during the lower VT strategy and 11.7 +/- 0.9 and 1.4 +/- 1.0 cm H2O during the traditional VT strategy (p < 0.01). The reduced mortality observed with the ARDSNet strategy may have been due to the protective effect of a higher PEEP(total).
Gabriella de Durante; Monica del Turco; Laura Rustichini; Patrizia Cosimini; Francesco Giunta; Leonard D Hudson; Arthur S Slutsky; V Marco Ranieri
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  165     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2002 May 
Date Detail:
Created Date:  2002-05-06     Completed Date:  2002-06-03     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1271-4     Citation Subset:  AIM; IM    
Dipartimento di Chirurgia-Terapia Intensiva, Cattedre di Anestesiologia e Rianimazione, Ospedale S. Chiara, Università di Pisa, Pisa, Italy.
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MeSH Terms
Analysis of Variance
Functional Residual Capacity
Positive-Pressure Respiration / methods*
Positive-Pressure Respiration, Intrinsic*
Respiratory Distress Syndrome, Adult / physiopathology,  therapy*
Comment In:
Am J Respir Crit Care Med. 2003 Apr 15;167(8):1150-1; author reply 1151   [PMID:  12684254 ]

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