Document Detail

PEEP-induced changes in lung volume in acute respiratory distress syndrome. Two methods to estimate alveolar recruitment.
MedLine Citation:
PMID:  21866369     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Lung volumes, especially functional residual capacity (FRC), are decreased in acute respiratory distress syndrome (ARDS). Positive end-expiratory pressure (PEEP) contributes to increased end-expiratory lung volume (EELV) and to improved oxygenation, but differentiating recruitment of previously nonaerated lung units from distension of previously open lung units remains difficult. This study evaluated simple methods derived from bedside EELV measurements to assess PEEP-induced lung recruitment while monitoring strain.
METHODS: Prospective multicenter study in 30 mechanically ventilated patients with ARDS in five university hospital ICUs. Two PEEP levels were studied, each for 45 min, and EELV (nitrogen washout/washin technique) was measured at both levels, with the difference (Δ) reflecting PEEP-induced lung volume changes. Alveolar recruitment was measured using pressure-volume (PV) curves. High and low recruiters were separated based on median recruitment at high PEEP. Minimum predicted increase in lung volume computed as the product of ΔPEEP by static compliance was subtracted from ΔEELV as an independent estimate of recruitment. Estimated and measured recruitments were compared. Strain induced by PEEP was also calculated from the same measurements.
RESULTS: FRC was 31 ± 11% of predicted. Median [25th-75th percentiles] PEEP-induced recruitment was 272 [187-355] mL. Estimated recruitment correlated with recruited volume measured on PV curves (ρ = 0.68), with a slope close to identity. The ΔEELV/FRC ratio differentiated high from low recruiters (110 [76-135] vs. 55 [23-70]%, p = 0.001). Strain increase due to PEEP was larger in high recruiters (p = 0.002).
CONCLUSION: PEEP-induced recruitment and strain can be assessed at the bedside using EELV measurement. We describe two bedside methods for predicting low or high alveolar recruitment during ARDS.
J Dellamonica; N Lerolle; C Sargentini; G Beduneau; F Di Marco; A Mercat; J C M Richard; J L Diehl; J Mancebo; J J Rouby; Q Lu; G Bernardin; L Brochard
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2011-08-25
Journal Detail:
Title:  Intensive care medicine     Volume:  37     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-09-22     Completed Date:  2012-02-01     Revised Date:  2012-04-03    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1595-604     Citation Subset:  IM    
Réanimation Médicale, AP-HP, Centre Hospitalier Albert Chenevier-Henri Mondor, Créteil, France.
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MeSH Terms
Lung Volume Measurements
Middle Aged
Positive-Pressure Respiration / methods*
Prospective Studies
Pulmonary Alveoli / physiopathology*
Respiratory Distress Syndrome, Adult / physiopathology*,  therapy*
Comment In:
Intensive Care Med. 2012 Mar;38(3):523-4; author reply 525-6   [PMID:  22310870 ]

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

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