| Experimental intra-abdominal hypertension attenuates the benefit of positive end-expiratory pressure in ventilating effusion-compressed lungs*. | |
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MedLine Citation:
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PMID: 22710205 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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OBJECTIVE: : To test the ability of positive end-expiratory pressure to offset the reduction of resting lung volume caused by intra abdominal hypertension, unilateral pleural effusion, and their combination. DESIGN: : Controlled application of intrapleural fluid, raised abdominal pressure and their combination before and after positive end-expiratory pressure in an anesthetized porcine model of controlled ventilation. SETTING: : Large animal laboratory of a university-affiliated hospital. SUBJECTS: : Fourteen deeply anesthetized swine (weight 30-35 kg). INTERVENTIONS: : Unilateral pleural effusion instillation (13 mL/kg), intra-abdominal hypertension (15 mm Hg), and simultaneous pleural effusion/intra abdominal hypertension. MEASUREMENTS: : Tidal compliance, end-expiratory lung aeration by gas dilution functional residual capacity, and quantitative analyses of computerized tomograms of the lungs at the extremes of the tidal cycle. MAIN RESULTS: : Positive end-expiratory pressure of 10 cm H2O (positive end-expiratory pressure10) increased mean functional residual capacity by 368 mL when pleural effusion was present and by 184 mL when intra-abdominal hypertension was present. When pleural effusion and intra-abdominal hypertension were simultaneously applied, positive end-expiratory pressure 10 failed to improve tidal compliance and increased functional residual capacity by only 77 mL, whereastidal recruitment during ventilation remained substantial. CONCLUSIONS: : The presence of intra-abdominal hypertension negates most of the positive end-expiratory pressure10 benefit in reversing pleural effusion-induced de-recruitment. Relief of intra-abdominal hypertension may be instrumental to the treatment of pleural effusion-associated lung restriction and cyclical tidal collapse and reopening. |
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Authors:
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Paolo Formenti; Jeronimo Graf; Gustavo A Cortes; Katherine Faltesek; Kenneth Gard; Alexander B Adams; Joseph Tashjian; David J Dries; John J Marini |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Critical care medicine Volume: 40 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2012 Jul |
Date Detail:
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Created Date: 2012-06-19 Completed Date: - 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: 2176-81 Citation Subset: AIM; IM |
Affiliation:
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From the Regions Hosptial (PF, GAC, KF, KG, ABA, JT, DJD, JJM), St. Paul, MN; andClinica Alemana (JG), Santiago, Chile. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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