Document Detail


Immediate application of positive-end expiratory pressure is more effective than delayed positive-end expiratory pressure to reduce extravascular lung water.
MedLine Citation:
PMID:  10075064     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine by the measurement of extravascular lung water (EVLW) whether the timing of positive-end expiratory pressure (PEEP) application influences the intensity of lung injury. DESIGN: Animal experimental study. SETTING: Animal experimental laboratory. SUBJECTS: Mixed-breed pigs (n = 18), aged 4 to 5 mos, weighing 25 to 30 kg. INTERVENTIONS: The animals were anesthetized and tracheotomized, after which a permeability pulmonary edema was instigated by infusing oleic acid (0.1/kg) into the central vein. All animals were then randomly divided into three groups. In group 1 (n = 5), 10 cm H2O of PEEP was applied immediately after the oleic acid infusion and maintained throughout the 6 hrs of the experiment. Group 2 (n = 7) received the same level of PEEP 120 mins after the insult for 4 hrs. Group 3 (n = 6), the control group, was ventilated without PEEP for the six hrs of the experiment. MEASUREMENTS AND MAIN RESULTS: At the end of the experiment, EVLW was calculated by gravimetric method. EVLW in group 1 (11.46+/-2.00 mL/kg) was significantly less than in group 2 (19.12+/-2.62 mL/kg) and group 3 (25.81+/-1.57 mL/kg), (p<.0001). Oxygenation also showed important differences by the end of the experiment when the Pao2/Fio2 ratio was significantly better in group 1 (467+/-73) than in group 2 (180+/-82) and group 3 (39+/-9), (p<.0001). CONCLUSIONS: The application of 10 cm H2O of PEEP reduces EVLW in a time-dependent manner and maximum protective effect is achieved if it is applied immediately after lung injury production.
Authors:
M Ruiz-Bailén; E Fernández-Mondéjar; B Hurtado-Ruiz; M Colmenero-Ruiz; R Rivera-Fernández; F Guerrero-López; G Vázquez-Mata
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  27     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  1999 Feb 
Date Detail:
Created Date:  1999-03-29     Completed Date:  1999-03-29     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  380-4     Citation Subset:  AIM; IM    
Affiliation:
Department of Intensive Medicine, Virgen de las Nieves Hospital, Granada, Spain.
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Animals
Carbon Dioxide / blood
Extravascular Lung Water / chemistry*
Hemodynamics
Oleic Acid
Oxygen / blood
Positive-Pressure Respiration*
Pulmonary Edema / blood,  chemically induced,  physiopathology,  therapy
Random Allocation
Swine
Time Factors
Chemical
Reg. No./Substance:
112-80-1/Oleic Acid; 124-38-9/Carbon Dioxide; 7782-44-7/Oxygen
Comments/Corrections
Comment In:
Crit Care Med. 1999 Feb;27(2):253-4   [PMID:  10075041 ]
Erratum In:
Crit Care Med 1999 Aug;27(8):1696

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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