Document Detail

Mechanical ventilation in acute respiratory failure: recruitment and high positive end-expiratory pressure are necessary.
MedLine Citation:
PMID:  15659941     Owner:  NLM     Status:  MEDLINE    
PURPOSE OF REVIEW: To review as best the critical care clinicians can recruit the acute respiratory distress syndrome (ARDS) lungs and keep the lungs opened, assuring homogeneous ventilation, and to present the experimental and clinical results of these mechanical ventilation strategies, along with possible improvements in patient outcome based on selected published medical literature from 1972 to 2004 (highlighting the period from June 2003 to June 2004 and recent results of the authors' group research). RECENT FINDINGS: In the experimental setting, repeated derecruitments accentuate lung injury during mechanical ventilation, whereas open lung concept strategies can attenuate lung injury. In the clinical setting, recruitment maneuvers improve short-term oxygenation in ARDS patients. A recent prospective clinical trial showed that low versus intermediate positive end-expiratory pressure (PEEP) levels (8 vs 13 cm H2O) associated with low tidal ventilation had the same effect on ARDS patient survival. Nevertheless, both conventional and electrical impedance thoracic tomography studies indicate that stepwise PEEP recruitment maneuvers increase lung volume and the recruitment percentage of lung tissue, and higher levels of PEEP (18-26 cm H2O) are necessary to keep the ARDS lungs opened and assure a more homogeneous low tidal ventilation. SUMMARY: Stepwise PEEP recruitment maneuvers can open collapsed ARDS lungs. Higher levels of PEEP are necessary to maintain the lungs open and assure homogenous ventilation in ARDS. In the near future, thoracic CT associated with high-performance monitoring of regional ventilation (electrical impedance tomography) may be used at the bedside to determine the optimal mechanical ventilation of ARDS patients.
Carmen Sílvia Valente Barbas; Gustavo Faissol Janot de Matos; Mariangela Pimentel Pincelli; Eduardo da Rosa Borges; Telma Antunes; Juliana Monteiro de Barros; Valdelis Okamoto; João Batista Borges; Marcelo Brito Passos Amato; Carlos Roberto Ribeiro de Carvalho
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in critical care     Volume:  11     ISSN:  1070-5295     ISO Abbreviation:  Curr Opin Crit Care     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-01-20     Completed Date:  2005-07-13     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9504454     Medline TA:  Curr Opin Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  18-28     Citation Subset:  IM    
Division of Pulmonary and Critical Care, University of São Paulo, São Paulo, Brazil; and Intensive Care Unit, Albert Einstein Hospital, São Paulo, Brazil.
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MeSH Terms
Lung / physiopathology,  radiography
Lung Volume Measurements
Positive-Pressure Respiration / methods*
Radiography, Thoracic
Respiratory Distress Syndrome, Adult / physiopathology,  radiography,  therapy*
Respiratory Mechanics
Treatment Outcome

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