| Alveolar recruitment versus hyperinflation: A balancing act. | |
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MedLine Citation:
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PMID: 17093370 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE OF REVIEW: To address lung recruitment according to pressure/volume curves, along with regional recruitment versus hyperinflation evidence from computed tomography and electrical impedance tomography. RECENT FINDINGS: Cyclical tidal volume recruitment of atelectatic lung regions causes acute lung injury, as do large breaths during pneumonectomy. Using the lower inflection point on the static pressure/volume inflation curve plus 2 cmH2O as a positive end-expiratory pressure setting limits hyperinflation in acute lung injury, but may not provide enough positive end-expiratory pressure to avoid cyclical recruitment/derecruitment injury in more severe acute lung injury regions. Both computed tomography and electrical impedance tomography can help titrate positive end-expiratory pressure in these regions, thereby assuring an 'open lung' ventilatory pattern. Regional pressure/volume curves show that adequate positive end-expiratory pressure for severe acute lung injury regions may not be reliably determined from whole lung pressure/volume curves. Balancing positive end-expiratory pressure requires both arterial PO2 and PCO2 values to determine at what level hyperinflated regions become seriously underperfused (develop very high ventilation-perfusion ratios), adding to the hypercarbia from increased deadspace. SUMMARY: Positive end-expiratory pressure levels must be high enough to minimize recruitment/derecruitment cycling. Balancing recruitment versus overdistension may require thoracic tomography, to assure sufficient improvement in oxygenation while limiting hypercarbia. |
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Authors:
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Ron Dueck |
Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Current opinion in anaesthesiology Volume: 19 ISSN: 0952-7907 ISO Abbreviation: Curr Opin Anaesthesiol Publication Date: 2006 Dec |
Date Detail:
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Created Date: 2006-11-09 Completed Date: 2007-02-15 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 8813436 Medline TA: Curr Opin Anaesthesiol Country: United States |
Other Details:
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Languages: eng Pagination: 650-4 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology, University of California, San Diego, California, USA. rdueck@ucsd.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Animals Continuous Positive Airway Pressure / adverse effects High-Frequency Ventilation / adverse effects Humans Lung Volume Measurements Plethysmography, Impedance / methods Positive-Pressure Respiration / adverse effects Pulmonary Alveoli / physiopathology*, radiography Pulmonary Atelectasis / physiopathology*, radiography, therapy Respiration, Artificial* / adverse effects Respiratory Distress Syndrome, Adult / physiopathology*, radiography, therapy Respiratory Mechanics Tidal Volume Tomography, X-Ray Computed / methods |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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