Document Detail

Hemodynamic and respiratory changes during lung recruitment and descending optimal positive end-expiratory pressure titration in patients with acute respiratory distress syndrome.
MedLine Citation:
PMID:  17255855     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To investigate respiratory and hemodynamic changes during lung recruitment and descending optimal positive end-expiratory pressure (PEEP) titration. DESIGN: Prospective auto-control clinical trial. SETTING: Adult general intensive care unit in a university hospital. PATIENTS: Eighteen patients with acute respiratory distress syndrome. INTERVENTIONS: Following baseline measurements (T0), PEEP was set at 26 cm H2O and lung recruitment was performed (40/40-maneuver). Then tidal volume was set at 4 mL/kg (T26R) and PEEP was lowered by 2 cm H2O in every 4 mins. Optimal PEEP was defined at 2 cm H2O above the PEEP where Pao2 dropped by > 10%. After setting the optimal PEEP, the 40/40-maneuver was repeated and tidal volume set at 6 mL/kg (T(end)). MEASUREMENTS AND MAIN RESULTS: Arterial blood gas analysis was done every 4 mins and hemodynamic measurements every 8 mins until T(end), then in 30 (T30) and 60 (T60) mins. The Pao2 increased from T0 to T(end) (203 +/- 108 vs. 322 +/- 101 mm Hg, p < .001), but the extravascular lung water (EVLW) did not change significantly. Cardiac index (CI) and the intrathoracic blood volume (ITBV) decreased from T0 to T26R (CI, 3.90 +/- 1.04 vs. 3.62 +/- 0.91 L/min/m2, p < .05; ITBVI, 832 +/- 205 vs. 795 +/- 188 m/m2, p < .05). There was a positive correlation between CI and ITBVI (r = .699, p < .01), a negative correlation between CI and central venous pressure (r = -.294, p < .01), and no correlation between CI and mean arterial pressure (MAP). CONCLUSIONS: Following lung recruitment and descending optimal PEEP titration, the Pao2 improves significantly, without any change in the EVLW up to 1 hr. This suggests a decrease in atelectasis as a result of recruitment rather than a reduction of EVLW. There is a significant change in CI during the maneuver, but neither central venous pressure, heart rate, nor MAP can reflect these changes.
Ildiko Toth; Tamas Leiner; Andras Mikor; Tamas Szakmany; Lajos Bogar; Zsolt Molnar
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  35     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-04-10     Completed Date:  2007-05-02     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  787-93     Citation Subset:  AIM; IM    
Department of Anaesthesia and Intensive Therapy, University of Pécs, Hungary.
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MeSH Terms
Air Pressure
Blood Pressure / physiology
Blood Volume / physiology*
Cardiac Output / physiology*
Central Venous Pressure / physiology
Extravascular Lung Water / physiology
Heart Rate / physiology
Hospitals, University
Lung / physiopathology*
Middle Aged
Oxygen / blood*
Positive-Pressure Respiration / methods*
Pulmonary Alveoli / physiopathology
Pulmonary Atelectasis / physiopathology,  therapy
Pulmonary Ventilation / physiology*
Respiratory Distress Syndrome, Adult / physiopathology*,  therapy
Stroke Volume / physiology*
Tidal Volume / physiology*
Reg. No./Substance:
Comment In:
Crit Care Med. 2007 Aug;35(8):1998-9; author reply 1999   [PMID:  17667256 ]
Crit Care Med. 2007 Mar;35(3):961-3   [PMID:  17421093 ]

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