| Effect of the chest wall on pressure-volume curve analysis of acute respiratory distress syndrome lungs. | |
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MedLine Citation:
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PMID: 18824918 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Previously published methods to assess the chest wall effect on total respiratory system pressure-volume (P-V) curves in acute respiratory distress syndrome have been performed on the lung and chest wall in isolation. We sought to quantify the effect of the chest wall by considering the chest wall and lung in series. DESIGN: Prospective study. SETTING: Academic health center medical and surgical intensive care units. PATIENTS: Twenty-two patients with acute respiratory distress syndrome/acute lung injury. INTERVENTIONS: Using a sigmoidal equation, we fit the pressure-volume data of the lung alone, and defined for each curve the pressure at the point of maximum compliance increase (Pmci), decrease (Pmcd), and the point of inflection (Pinf). We calculated the pressure to which the total respiratory system must be inflated to achieve a volume that would place the lung at each point of interest. We compared these "corrected" pressures (Pmci,c, Pmcd,c, and Pinf,c) to the measured values of the total respiratory system. MEASUREMENTS AND MAIN RESULTS: The average difference between Pmci and Pmci,c was 0.12 cm H2O on inflation (2sd = 5.6 cm H2O) and -1.4 cm H2O on deflation (2sd = 5.0 cm H2O); between Pmcd and Pmcd,c was 1.73 cm H2O on inflation (2sd = 4.5 cm H2O) and -0.15 cm H2O on deflation (2sd = 4.9 cm H2O); and between Pinf and Pinf,c was 0.14 cm H2O on inflation (2sd = 6.7 cm H2O) and -0.35 cm H2O on deflation (2sd = 5.0 cm H2O). CONCLUSIONS: This method of "correcting" the total respiratory system P-V curve for the chest wall allows for calculation of an airway pressure that would place the lung at a desired volume on its P-V curve. For most patients, the chest wall had little influence on the total respiratory system P-V curve. However, there were patients in whom the chest wall did potentially have clinical significance. |
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Authors:
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Robert L Owens; Dean R Hess; Atul Malhotra; José G Venegas; R Scott Harris |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Critical care medicine Volume: 36 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2008 Nov |
Date Detail:
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Created Date: 2008-10-22 Completed Date: 2008-11-17 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 2980-5 Citation Subset: AIM; IM |
Affiliation:
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Departments of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Female Humans Lung / physiopathology* Lung Compliance Male Middle Aged Pressure Prospective Studies Respiratory Distress Syndrome, Adult / physiopathology* Thoracic Wall / physiopathology* |
| Grant Support | |
ID/Acronym/Agency:
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HL04501/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2008 Nov;36(11):3100-1
[PMID:
18941312
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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