Document Detail

Intercomparison of recruitment maneuver efficacy in three models of acute lung injury.
MedLine Citation:
PMID:  15599138     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To compare the relative efficacy of three forms of recruitment maneuvers in diverse models of acute lung injury characterized by differing pathoanatomy.
DESIGN: We compared three recruiting maneuver (RM) techniques at three levels of post-RM positive end-expiratory pressure in three distinct porcine models of acute lung injury: oleic acid injury; injury induced purely by the mechanical stress of high-tidal airway pressures; and pneumococcal pneumonia.
SETTING: Laboratory in a clinical research facility.
SUBJECTS: Twenty-eight anesthetized mixed-breed pigs (23.8 +/- 2.6 kg).
INTERVENTIONS: The RM techniques tested were sustained inflation, extended sigh or incremental positive end-expiratory pressure, and pressure-controlled ventilation.
PRIMARY MEASUREMENTS: Oxygenation and end-expiratory lung volume.
MAIN RESULTS: The post-RM positive end-expiratory pressure level was the major determinant of post-maneuver PaO2, independent of the RM technique. The pressure-controlled ventilation RM caused a lasting increase of PaO2 in the ventilator-induced lung injury model, but in oleic acid injury and pneumococcal pneumonia, there were no sustained oxygenation differences for any RM technique (sustained inflation, incremental positive end-expiratory pressure, or pressure-controlled ventilation) that differed from raising positive end-expiratory pressure without RM.
CONCLUSIONS: Recruitment by pressure-controlled ventilation is equivalent or superior to sustained inflation, with the same peak pressure in all tested models of acute lung injury, despite its lower mean airway pressure and reduced risk for hemodynamic compromise. Although RM may improve PaO2 in certain injury settings when traditional tidal volumes are used, sustained improvement depends on the post-RM positive end-expiratory pressure value.
Sung-Chul Lim; Alexander B Adams; Dana A Simonson; David J Dries; Alain F Broccard; John R Hotchkiss; John J Marini
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Critical care medicine     Volume:  32     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2004-12-15     Completed Date:  2005-01-27     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2371-7     Citation Subset:  AIM; IM    
Department of Pulmonary/Critical Care Medicine, Regions Hospital, University of Minnesota, St. Paul, MN, USA.
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MeSH Terms
Analysis of Variance
Disease Models, Animal
Lung Compliance
Lung Volume Measurements
Oleic Acid
Pneumonia, Pneumococcal
Positive-Pressure Respiration / methods*
Pulmonary Gas Exchange
Respiration, Artificial
Respiratory Distress Syndrome, Adult / physiopathology,  therapy*
Respiratory Function Tests
Respiratory Mechanics / physiology*
Risk Factors
Sensitivity and Specificity
Grant Support
50152//PHS HHS
Reg. No./Substance:
112-80-1/Oleic Acid
Comment In:
Crit Care Med. 2004 Dec;32(12):2540-1   [PMID:  15599163 ]

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

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