Document Detail


Alveolar recruitment in pulmonary and extrapulmonary acute respiratory distress syndrome: comparison using pressure-volume curve or static compliance.
MedLine Citation:
PMID:  17264713     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Alveolar recruitment in response to positive end-expiratory pressure (PEEP) may differ between pulmonary and extrapulmonary acute respiratory distress syndrome (ARDS), and alveolar recruitment values may differ when measured by pressure-volume curve compared with static compliance. METHODS: The authors compared PEEP-induced alveolar recruitment in 71 consecutive patients identified in a database. Patients were classified as having pulmonary, extrapulmonary, or mixed/uncertain ARDS. Pressure-volume curves with and without PEEP were available for all patients, and pressure-volume curves with two PEEP levels were available for 44 patients. Static compliance was calculated as tidal volume divided by pressure change for tidal volumes of 400 and 700 ml. Recruited volume was measured at an elastic pressure of 15 cm H2O. RESULTS: Volume recruited by PEEP (10 +/- 3 cm H2O) was 223 +/- 111 ml in the pulmonary ARDS group (29 patients), 206 +/- 164 ml in the extrapulmonary group (16 patients), and 242 +/- 176 ml in the mixed/uncertain group (26 patients) (P = 0.75). At high PEEP (14 +/- 2 cmH2O, 44 patients), recruited volumes were also similar (P = 0.60). With static compliance, recruitment was markedly underestimated and was dependent on tidal volume (226 +/- 148 ml using pressure-volume curve, 95 +/- 185 ml for a tidal volume of 400 ml, and 23 +/- 169 ml for 700 ml; P < 0.001). CONCLUSION: In a large sample of patients, classification of ARDS was uncertain in more than one third of patients, and alveolar recruitment was similar in pulmonary and extrapulmonary ARDS. PEEP levels should not be determined based on cause of ARDS.
Authors:
Arnaud W Thille; Jean-Christophe M Richard; Salvatore M Maggiore; V Marco Ranieri; Laurent Brochard
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Anesthesiology     Volume:  106     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-01-31     Completed Date:  2007-03-12     Revised Date:  2008-01-23    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  212-7     Citation Subset:  AIM; IM    
Affiliation:
Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, France. arnaud.thille@orange.fr
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Female
Humans
Lung Compliance / physiology*
Lung Volume Measurements
Male
Middle Aged
Positive-Pressure Respiration
Pressure
Pulmonary Alveoli / physiopathology*
Respiratory Distress Syndrome, Adult / classification,  physiopathology*
Comments/Corrections
Comment In:
Anesthesiology. 2008 Jan;108(1):165; author reply 165-6   [PMID:  18156897 ]
Anesthesiology. 2007 Feb;106(2):203-4   [PMID:  17264709 ]

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