Document Detail

Alterations of lung and chest wall mechanics in patients with acute lung injury: effects of positive end-expiratory pressure.
MedLine Citation:
PMID:  7633703     Owner:  NLM     Status:  MEDLINE    
In 16 mechanically ventilated patients with acute lung injury (ALI) (eight patients with moderate ALI [moderate group], eight patients with severe ALI [adult respiratory distress syndrome, ARDS group]) and in eight normal anesthetized-paralyzed subjects (control group), we partitioned the total respiratory system mechanics into the lung (L) and chest wall (w) mechanics using the esophageal balloon technique together with the airway occlusion technique during constant flow inflation. We measured lung elastance (Est,L), chest wall elastance (Est,w), and total lung (Rmax, L) and chest wall (Rmax,w) resistance. Rmax,L includes airway (Rmin,L) and "additional" lung resistance (DR,L). DR,L represents the "additional" component due to the viscoelastic phenomena of the lung tissues and time-constant inequalities (pendelluft). Measurements were repeated at 0, 5, and 10 cm H2O of positive end-expiratory pressure (PEEP) in the control group and at 0, 5, 10, and 15 cm H2O PEEP in patients with ALI. The end-expiratory lung volume (EELV) was measured at each level of PEEP. Specific total lung (sRmax,L), airway (sRmin,L), and "additional" lung (sDR,L) resistances were obtained as Rmax,L x EELV, Rmin,L x EELV, and DR,L x EELV, respectively. At PEEP 0 cm H2O, we found that both Est,L (23.7 +/- 5.5 and 13.8 +/- 3.3 versus 9.3 +/- 1.7 cm H2O/L; p < 0.01) and Est,w (13.2 +/- 5.4 and 9.9 +/- 2.1 versus 5.6 +/- 2.3 cm H2O/L; p < 0.01) were markedly increased in patients with ARDS and moderate ALI compared with control subjects, with a significant (p < 0.01) effect of the severity of the disease on Est,L (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
P Pelosi; M Cereda; G Foti; M Giacomini; A Pesenti
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  152     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  1995 Aug 
Date Detail:
Created Date:  1995-09-14     Completed Date:  1995-09-14     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:  531-7     Citation Subset:  AIM; IM    
Istituto di Anestesia e Rianimazione, Università di Milano, Italy.
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MeSH Terms
Airway Resistance
Balloon Dilatation
Case-Control Studies
Forced Expiratory Volume
Functional Residual Capacity
Lung / physiopathology*
Lung Compliance
Lung Volume Measurements
Middle Aged
Positive-Pressure Respiration*
Pulmonary Ventilation / physiology
Respiratory Distress Syndrome, Adult / physiopathology*,  therapy*
Respiratory Mechanics*
Thorax / physiopathology*

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