Document Detail


Monitoring dead space during recruitment and PEEP titration in an experimental model.
MedLine Citation:
PMID:  17047925     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To test the usefulness of dead space for determining open-lung PEEP, the lowest PEEP that prevents lung collapse after a lung recruitment maneuver. DESIGN: Prospective animal study. SETTING: Department of Clinical Physiology, University of Uppsala, Sweden. SUBJECTS: Eight lung-lavaged pigs. INTERVENTIONS: Animals were ventilated using constant flow mode with VT of 6ml/kg, respiratory rate of 30bpm, inspiratory-to-expiratory ratio of 1:2, and FiO(2) of 1. Baseline measurements were performed at 6cmH(2)O of PEEP. PEEP was increased in steps of 6cmH(2)O from 6 to 24cmH(2)O. Recruitment maneuver was achieved within 2min at pressure levels of 60/30cmH(2)O for Peak/PEEP. PEEP was decreased from 24 to 6cmH(2)O in steps of 2cmH(2)O and then to 0cmH(2)O. Each PEEP step was maintained for 10min. MEASUREMENTS AND RESULTS: Alveolar dead space (VD(alv)), the ratio of alveolar dead space to alveolar tidal volume (VD(alv)/VT(alv)), and the arterial to end-tidal PCO(2) difference (Pa-ET: CO(2)) showed a good correlation with PaO(2), normally aerated areas, and non-aerated CT areas in all animals (minimum-maximum r(2)=0.83-0.99; p<0.01). Lung collapse (non-aerated tissue>5%) started at 12[Symbol: see text]cmH(2)O PEEP; hence, open-lung PEEP was established at 14cmH(2)O. The receiver operating characteristics curve demonstrated a high specificity and sensitivity of VD(alv) (0.89 and 0.90), VD(alv)/VT(alv) (0.82 and 1.00), and Pa-ET: CO(2) (0.93 and 0.95) for detecting lung collapse. CONCLUSIONS: Monitoring of dead space was useful for detecting lung collapse and for establishing open-lung PEEP after a recruitment maneuver.
Authors:
Gerardo Tusman; Fernando Suarez-Sipmann; Stephan H Böhm; Tanja Pech; Hajo Reissmann; Gustavo Meschino; Adriana Scandurra; Göran Hedenstierna
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-09-19
Journal Detail:
Title:  Intensive care medicine     Volume:  32     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-10-20     Completed Date:  2007-02-23     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1863-71     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina. gtusman@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Animals
Positive-Pressure Respiration / methods*
Prospective Studies
Pulmonary Alveoli / physiopathology*
Pulmonary Atelectasis / prevention & control*
Pulmonary Gas Exchange
Pulmonary Ventilation
ROC Curve
Respiratory Dead Space*
Respiratory Distress Syndrome, Adult / therapy*
Respiratory Function Tests / methods*
Sensitivity and Specificity
Swine
Tidal Volume
Comments/Corrections
Comment In:
Intensive Care Med. 2006 Nov;32(11):1686-8   [PMID:  17047924 ]

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


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