Document Detail

The impact of spontaneous ventilation on distribution of lung aeration in patients with acute respiratory distress syndrome: airway pressure release ventilation versus pressure support ventilation.
MedLine Citation:
PMID:  19923518     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In this study, we sought to determine which mode, airway pressure release ventilation (APRV) or pressure support ventilation (PSV), decreases atelectasis more in patients with acute lung injury/acute respiratory distress syndrome (ARDS). METHODS: This was a retrospective study in the intensive care unit. Between 2006 and 2007, we identified 18 patients with acute lung injury/ARDS who received either APRV or PSV and had a helical computed tomography scan twice in 3 days. RESULTS: Computed tomography data from the APRV and PSV groups (n = 9 each) were analyzed for 3-dimensional reconstruction and volumetry. Aerated lung regions (normally aerated, poorly aerated, nonaerated, and hyperinflated) were identified by their densities in Hounsfield units. The Pao(2)/Fio(2) ratio and alveolar-arteriolar oxygen gradient after ventilation were improved in both groups (P = 0.008); however, the improvements in the APRV group exceeded those in the PSV group when delivered with equal mean airway pressure (P = 0.018 and 0.015, respectively). Atelectasis decreased significantly from 41% (range, 17%-68%) to 19% (range, 6%-40%) (P = 0.008) and normally aerated volume increased significantly from 29% (range, 13%-41%) to 43% (range, 25%-56%) (P = 0.008) in the APRV group, whereas lung volume did not change in the PSV group. CONCLUSIONS: Spontaneous ventilation during APRV improves lung aeration by decreasing atelectasis. PSV for gas exchange is effective but not sufficient to improve lung aeration. These results indicate that APRV is more efficient than PSV as a mode of primary ventilatory support to decrease atelectasis in patients with ARDS.
Takeshi Yoshida; Hiroshi Rinka; Arito Kaji; Akira Yoshimoto; Hideki Arimoto; Toshinori Miyaichi; Masanori Kan
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  109     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-20     Completed Date:  2009-12-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1892-900     Citation Subset:  AIM; IM    
Intensive Care Unit, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan.
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MeSH Terms
Acute Lung Injury / complications,  physiopathology,  radiography,  therapy*
Aged, 80 and over
Continuous Positive Airway Pressure*
Imaging, Three-Dimensional
Intensive Care Units
Lung / physiopathology*,  radiography
Lung Volume Measurements
Middle Aged
Pulmonary Atelectasis / etiology,  physiopathology,  prevention & control*,  radiography
Pulmonary Gas Exchange*
Pulmonary Ventilation*
Radiographic Image Interpretation, Computer-Assisted
Respiration, Artificial / methods*
Respiratory Distress Syndrome, Adult / complications,  physiopathology,  radiography,  therapy*
Retrospective Studies
Time Factors
Tomography, Spiral Computed
Treatment Outcome

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

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