|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.|
|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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|Type: Comparative Study; Journal Article|
|Title: Anesthesia and analgesia Volume: 109 ISSN: 1526-7598 ISO Abbreviation: Anesth. Analg. Publication Date: 2009 Dec|
|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|
|Languages: eng Pagination: 1892-900 Citation Subset: AIM; IM|
|Intensive Care Unit, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. firstname.lastname@example.org|
|APA/MLA Format Download EndNote Download BibTex|
Acute Lung Injury
Aged, 80 and over
Continuous Positive Airway Pressure*
Intensive Care Units
Lung / physiopathology*, radiography
Lung Volume Measurements
Pulmonary Atelectasis / etiology, physiopathology, prevention & control*, radiography
Pulmonary Gas Exchange*
Radiographic Image Interpretation, Computer-Assisted
Respiration, Artificial / methods*
Respiratory Distress Syndrome, Adult / complications, physiopathology, radiography, therapy*
Tomography, Spiral Computed
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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