Document Detail

Effects of high versus low positive end-expiratory pressures in acute respiratory distress syndrome.
MedLine Citation:
PMID:  15665322     Owner:  NLM     Status:  MEDLINE    
A recent study by the Acute Respiratory Distress Syndrome Network compared the traditional lower end-expiratory pressure strategy with a higher end-expiratory pressure strategy in patients with the acute respiratory distress syndrome ventilated with low tidal volumes. Clinical outcomes were similar whether lower or higher positive end-expiratory pressure (PEEP) levels were used. We applied both the lower (9 +/- 2 cm H2O) and higher (16 +/- 1 cm H2O) PEEP strategy in 19 patients. In nine recruiters, the higher end-expiratory pressure strategy resulted in significant alveolar recruitment (587 +/- 158 ml), improvement in arterial oxygen partial pressure/inspired oxygen fraction ratio (from 150 +/- 36 to 396 +/- 138), and reduction in static lung elastance (from 23 +/- 3 to 20 +/- 2 cm H2O/L). In 10 nonrecruiters, alveolar recruitment was minimal, oxygenation did not improve, and static lung elastance significantly increased (from 26 +/- 5 to 28 +/- 6 cm H2O/L). The increase in oxygenation, the reduction in static lung elastance, and the shape of the volume-pressure curve during the lower PEEP strategy were independently associated with alveolar recruitment. In conclusion, the protocol proposed by the Acute Respiratory Distress Syndrome Network, lacking solid physiologic basis, frequently fails to induce alveolar recruitment and may increase the risk of alveolar overinflation.
Salvatore Grasso; Vito Fanelli; Aldo Cafarelli; Roberto Anaclerio; Marilisa Amabile; Giovanni Ancona; Tommaso Fiore
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2005-01-21
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  171     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2005 May 
Date Detail:
Created Date:  2005-04-25     Completed Date:  2005-06-23     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:  1002-8     Citation Subset:  AIM; IM    
Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Ospedale Policlinico, Piazza Giulio Cesare 11, Bari, Italy 70124.
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MeSH Terms
Aged, 80 and over
Linear Models
Lung Volume Measurements
Middle Aged
Positive-Pressure Respiration / methods*
Pulmonary Alveoli / physiopathology
Pulmonary Gas Exchange
Respiratory Distress Syndrome, Adult / physiopathology,  therapy*

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