| Physiological effects of an open lung ventilatory strategy titrated on elastance-derived end-inspiratory transpulmonary pressure: study in a pig model*. | |
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MedLine Citation:
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PMID: 22564955 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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RATIONALE: In the presence of increased chest wall elastance, the airway pressure does not reflect the lung-distending (transpulmonary) pressure. OBJECTIVE: To compare the physiological effects of a conventional open lung approach titrated for an end-inspiratory airway opening plateau pressure (30 cm H2O) with a transpulmonary open lung approach titrated for a elastance-derived end-inspiratory plateau transpulmonary pressure (26 cm H2O), in a pig model of acute respiratory distress syndrome (HCl inhalation) and reversible chest wall mechanical impairment (chest wall and abdomen restriction). METHODS: In eight pigs, physiological parameters and computed tomography were recorded under three conditions: 1) conventional open lung approach, normal chest wall; 2) conventional open lung approach, stiff chest wall; and 3) transpulmonary open lung approach, stiff chest wall. MEASUREMENTS AND MAIN RESULTS: As compared with the normal chest wall condition, at end-expiration non aerated lung tissue weight was increased by 116 ± 68 % during the conventional open lung approach and by 28 ± 41 % during the transpulmonary open lung approach (p < .01), whereas cardiac output was decreased by 27 ± 19 % and 22 ± 14 %, respectively (p = not significant). CONCLUSION: In this model, the end-inspiratory transpulmonary open lung approach minimized the impact of chest wall stiffening on alveolar recruitment without causing hemodynamic impairment. |
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Authors:
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Francesco Staffieri; Tania Stripoli; Valentina De Monte; Antonio Crovace; Marianna Sacchi; Michele De Michele; Paolo Trerotoli; Pierpaolo Terragni; V Marco Ranieri; Salvatore Grasso |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Critical care medicine Volume: 40 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2012 Jul |
Date Detail:
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Created Date: 2012-06-19 Completed Date: 2012-09-25 Revised Date: 2013-02-07 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 2124-31 Citation Subset: AIM; IM |
Affiliation:
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Dipartimento dell'Emergenza e Trapianti d'Organo, Sezione di Chirurgia Veterinaria, Università degli Studi Aldo Moro, Bari, Italy. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Lung Injury
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therapy Animals Blood Volume Carbon Dioxide / blood Cardiac Output Continuous Positive Airway Pressure Disease Models, Animal Lung Volume Measurements Oxygen / blood Positive-Pressure Respiration / methods* Radiography, Thoracic Stroke Volume Swine Tomography, X-Ray Computed |
| Chemical | |
Reg. No./Substance:
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124-38-9/Carbon Dioxide; 7782-44-7/Oxygen |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2012 Jul;40(7):2249-50
[PMID:
22710221
]
Crit Care Med. 2013 Jan;41(1):e9 [PMID: 23269177 ] Crit Care Med. 2013 Jan;41(1):e1 [PMID: 23269160 ] Crit Care Med. 2013 Jan;41(1):e9-10 [PMID: 23269178 ] |
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