| Lung collapse during low tidal volume ventilation in acute respiratory distress syndrome. | |
| | |
MedLine Citation:
|
PMID: 11175238 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Current ventilator management for acute respiratory distress syndrome (ARDS) incorporates low tidal volume (V(T)) ventilation in order to limit ventilator-induced lung injury. Low V(T) ventilation in supine patients, without the use of intermittent hyperinflations, may cause small airway closure, progressive atelectasis, and secretion retention. Use of high positive end-expiratory pressure (PEEP) levels with low V(T) ventilation may not counter this effect, because regional differences in intra-abdominal hydrostatic pressure may diminish the volume-stabilizing effects of PEEP. CASE SUMMARY: A 35-year-old man with abdominal compartment syndrome (intra-abdominal pressure > 48 cm H2O developed ARDS and was treated with V(T) of 4.5 mL/kg and PEEP of 20 cm H2O. Despite aggressive fluid therapy, appropriate airway humidification and tracheal suctioning, the patient developed complete bronchial obstruction, involving the entire right lung and left upper lobe. After bronchoscopy the patient was placed on a higher V(T) (7.0 mL/kg). Intermittent PEEP was instituted at 30 cm H2O for 2 breaths every 3 minutes. This intermittently raised the end-inspiratory plateau pressure from 38 cm H2O to 50 cm H2O. With the same airway humidity and tracheal suctioning practices bronchial obstruction did not reoccur. CONCLUSION: Low V(T) ventilation in ARDS may increase the risk of small airway closure and retained secretions. This adverse effect highlights the importance of pulmonary hygiene measures in ARDS during lung-protective ventilation. |
| | |
Authors:
|
R H Kallet; M S Siobal; J A Alonso; E L Warnecke; J A Katz; J D Marks |
Related Documents
:
|
1986678 - Effects of positive end-expiratory pressure on the gradient for venous return. 20219698 - Partitioning of exhaled no in ventilated patients undergoing cardiac surgery. 11700418 - Comparison of lung protective ventilation strategies in a rabbit model of acute lung in... 12615628 - Positive end-expiratory pressure after a recruitment maneuver prevents both alveolar co... 6814298 - Hemodynamic effects of intravenous nitroglycerin: importance of the delivery system. 18052358 - Reversible hydrogen storage property and structural analysis for face-centered cubic hy... |
Publication Detail:
|
Type: Case Reports; Journal Article |
Journal Detail:
|
Title: Respiratory care Volume: 46 ISSN: 0020-1324 ISO Abbreviation: Respir Care Publication Date: 2001 Jan |
Date Detail:
|
Created Date: 2001-02-22 Completed Date: 2001-03-22 Revised Date: 2008-11-21 |
Medline Journal Info:
|
Nlm Unique ID: 7510357 Medline TA: Respir Care Country: United States |
Other Details:
|
Languages: eng Pagination: 49-52 Citation Subset: IM |
Affiliation:
|
Respiratory Care Services, Department of Anesthesia, University of California-San Francisco, at San Francisco General Hospital, NH:GA2, 1001 Potrero Avenue, San Francisco CA 94110, USA. richkallet@earthlink.net |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Humans Male Positive-Pressure Respiration Pulmonary Atelectasis / etiology* Respiration, Artificial / adverse effects*, methods Respiratory Distress Syndrome, Adult / physiopathology, therapy* Respiratory System / secretion Tidal Volume* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Nebulization of a suspension of budesonide and a solution of terbutaline into a neonatal ventilator ...
Next Document: 2000 Donald F. Egan Scientific Lecture. Are respiratory therapists effective? Assessing the evidence...