Document Detail


Physiological effects of an open lung ventilatory strategy titrated on elastance-derived end-inspiratory transpulmonary pressure: study in a pig model*.
MedLine Citation:
PMID:  22564955     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  40     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-19     Completed Date:  2012-09-25     Revised Date:  2013-02-07    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2124-31     Citation Subset:  AIM; IM    
Affiliation:
Dipartimento dell'Emergenza e Trapianti d'Organo, Sezione di Chirurgia Veterinaria, Università degli Studi Aldo Moro, Bari, Italy.
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MeSH Terms
Descriptor/Qualifier:
Acute Lung Injury / 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:
124-38-9/Carbon Dioxide; 7782-44-7/Oxygen
Comments/Corrections
Comment In:
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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