Document Detail

ARDSnet ventilatory protocol and alveolar hyperinflation: role of positive end-expiratory pressure.
MedLine Citation:
PMID:  17656676     Owner:  NLM     Status:  MEDLINE    
RATIONALE: In patients with acute respiratory distress syndrome (ARDS), a focal distribution of loss of aeration in lung computed tomography predicts low potential for alveolar recruitment and susceptibility to alveolar hyperinflation with high levels of positive end-expiratory pressure (PEEP). OBJECTIVES: We tested the hypothesis that, in this cohort of patients, the table-based PEEP setting criteria of the National Heart, Lung, and Blood Institute's ARDS Network (ARDSnet) low tidal volume ventilatory protocol could induce tidal alveolar hyperinflation. METHODS: In 15 patients, physiologic parameters and plasma inflammatory mediators were measured during two ventilatory strategies, applied randomly: the ARDSnet and the stress index strategy. The latter used the same ARDSnet ventilatory pattern except for the PEEP level, which was adjusted based on the stress index, a monitoring tool intended to quantify tidal alveolar hyperinflation and/or recruiting/derecruiting that occurs during constant-flow ventilation, on a breath-by-breath basis. MEASUREMENTS AND MAIN RESULTS: In all patients, the stress index revealed alveolar hyperinflation during application of the ARDSnet strategy, and consequently, PEEP was significantly decreased (P < 0.01) to normalize the stress index value. Static lung elastance (P = 0.01), plasma concentrations of interleukin-6 (P < 0.01), interleukin-8 (P = 0.031), and soluble tumor necrosis factor receptor I (P = 0.013) were significantly lower during the stress index as compared with the ARDSnet strategy-guided ventilation. CONCLUSIONS: Alveolar hyperinflation in patients with focal ARDS ventilated with the ARDSnet protocol is attenuated by a physiologic approach to PEEP setting based on the stress index measurement.
Salvatore Grasso; Tania Stripoli; Michele De Michele; Francesco Bruno; Marco Moschetta; Giuseppe Angelelli; Irene Munno; Vincenzo Ruggiero; Roberto Anaclerio; Aldo Cafarelli; Bernd Driessen; Tommaso Fiore
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2007-07-26
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  176     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-04     Completed Date:  2007-12-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  761-7     Citation Subset:  AIM; IM    
Università di Bari, Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Ospedale Policlinico, Piazza Giulio Cesare 11, Bari 70124, Italy.
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MeSH Terms
Aged, 80 and over
Cardiac Output / physiology
Cohort Studies
Interleukin-6 / blood
Interleukin-8 / blood
Middle Aged
Positive-Pressure Respiration / methods*
Pulmonary Alveoli / physiopathology*
Pulmonary Gas Exchange / physiology
Receptors, Tumor Necrosis Factor, Type I / blood
Respiratory Distress Syndrome, Adult / physiopathology*,  therapy
Respiratory Mechanics / physiology
Tidal Volume / physiology
Vascular Resistance / physiology
Reg. No./Substance:
0/Interleukin-6; 0/Interleukin-8; 0/Receptors, Tumor Necrosis Factor, Type I

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