| Monitoring dead space during recruitment and PEEP titration in an experimental model. | |
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MedLine Citation:
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PMID: 17047925 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Gerardo Tusman; Fernando Suarez-Sipmann; Stephan H Böhm; Tanja Pech; Hajo Reissmann; Gustavo Meschino; Adriana Scandurra; Göran Hedenstierna |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2006-09-19 |
Journal Detail:
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Title: Intensive care medicine Volume: 32 ISSN: 0342-4642 ISO Abbreviation: Intensive Care Med Publication Date: 2006 Nov |
Date Detail:
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Created Date: 2006-10-20 Completed Date: 2007-02-23 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 1863-71 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina. gtusman@hotmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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Intensive Care Med. 2006 Nov;32(11):1686-8
[PMID:
17047924
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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