Document Detail

Experimental intra-abdominal hypertension attenuates the benefit of positive end-expiratory pressure in ventilating effusion-compressed lungs*.
MedLine Citation:
PMID:  22710205     Owner:  NLM     Status:  In-Data-Review    
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.
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:
Type:  Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  40     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2176-81     Citation Subset:  AIM; IM    
From the Regions Hosptial (PF, GAC, KF, KG, ABA, JT, DJD, JJM), St. Paul, MN; andClinica Alemana (JG), Santiago, Chile.
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