Document Detail

Impairment of lung and chest wall mechanics in patients with acute respiratory distress syndrome: role of abdominal distension.
MedLine Citation:
PMID:  9351606     Owner:  NLM     Status:  MEDLINE    
Recent data have suggested that the elastic properties of the chest wall (CW) may be compromised in patients with ARDS because of abdominal distension (4). We partitioned CW and lung (L) mechanics, assessed the role of abdominal distension, and verified whether the underlying disease responsible for ARDS affects the impairment of respiratory mechanics. Volume-pressure (V-P) curves (interrupter technique) were assessed in nine patients with surgical ARDS and nine patients with medical ARDS. Relative to nine patients undergoing heart surgery, V-P curves of the respiratory system (rs) and L of patients with surgical or medical ARDS showed a rightward displacement. V-P curves of the CW and the L showed an upward concavity in patients with medical ARDS and a downward concavity in patients with surgical ARDS. Although the CW and the abdomen (abd) V-P curves in patients with medical ARDS were similar to those obtained in patients undergoing heart surgery, they showed a rightward shift and a downward flattening in patients with surgical ARDS. In five of these patients, a reduction in static end-inspiratory pressure of the abd (69+/-4%), rs (30+/-3%), CW (41+/-2%), and L (27+/-3%) was observed after abdominal decompression for acute bleeding. Abdominal decompression therefore caused an upward and leftward shift of the V-P curves of the respiratory system, chest wall, lung, and abdomen. In conclusion we showed that impairment of the elastic properties of the respiratory system may vary with the underlying disease responsible for ARDS. The flattening of the V-P curve at high pressures observed in some patients with ARDS may be due to an increase in chest wall elastance related to abdominal distension. These observations have implications for the assessment and ventilatory management of patients with ARDS.
V M Ranieri; N Brienza; S Santostasi; F Puntillo; L Mascia; N Vitale; R Giuliani; V Memeo; F Bruno; T Fiore; A Brienza; A S Slutsky
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  156     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  1997 Oct 
Date Detail:
Created Date:  1997-11-18     Completed Date:  1997-11-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1082-91     Citation Subset:  AIM; IM    
Istituto di Anestesiologia e Rianimazione, Università di Bari, Ospedale Policlinico, Italia.
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MeSH Terms
Abdomen / physiology*
Acute Disease
Cardiac Surgical Procedures / adverse effects
Infant, Newborn
Lung / physiopathology*
Respiration, Artificial / methods
Respiratory Distress Syndrome, Newborn / etiology,  physiopathology*,  therapy
Respiratory Mechanics / physiology*
Thorax / physiopathology*

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