Document Detail

Positive end-expiratory pressure above lower inflection point minimizes influx of activated neutrophils into lung.
MedLine Citation:
PMID:  15599153     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To compare the effects of low vs. high tidal volume (Vt) with three positive end-expiratory pressure (PEEP) strategies on activated neutrophil influx into the lung. DESIGN: Prospective, randomized controlled animal study. SETTING: Animal laboratory in a university hospital. SUBJECTS: Newborn piglets. INTERVENTIONS: Surfactant-depleted piglets were randomized in littermate pairs; to PEEP of either 0 (zero end-expiratory pressure [ZEEP]; n = 6), 8 cm H2O (PEEP 8; n = 5), or 1 cm H2O above the lower inflection point (LIP) (PEEP>LIP; n = 6). Within each pair piglets were randomized to a low VT (5-7 mL/kg) or high VT strategy (17-19 mL/kg). After 4 hrs of mechanical ventilation, 18-fluorodeoxyglucose (18FDG) was injected and positron emission tomography scanning was performed. MEASUREMENTS AND MAIN RESULTS: VT and PEEP changes on influx constants of 18FDG were assessed by analysis of variance. A within-litter comparison of Vt was nonsignificant (p = .50). A between-litter comparison, ordered in linear trend rank, from ZEEP, to PEEP 8, to PEEP>LIP, showed a strong effect of PEEP on influx constant (p = .019). CONCLUSIONS: PEEP set above the LIP on the inspiratory limb of the pressure-volume curve affords a stronger lung protection than VT strategy.
Shelley L Monkman; Chad C Andersen; Claude Nahmias; Hasan Ghaffer; Jacqueline M Bourgeois; Robin S Roberts; Barbara Schmidt; Haresh M Kirpalani
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  32     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2004-12-15     Completed Date:  2005-01-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2471-5     Citation Subset:  AIM; IM    
Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
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MeSH Terms
Animals, Newborn
Biopsy, Needle
Cell Movement
Disease Models, Animal
Lung Compliance
Neutrophils / physiology*
Positive-Pressure Respiration / methods*
Positron-Emission Tomography
Pulmonary Ventilation
Random Allocation
Respiratory Distress Syndrome, Adult / pathology*,  radionuclide imaging,  therapy*
Sensitivity and Specificity
Tidal Volume
Comment In:
Crit Care Med. 2004 Dec;32(12):2553-4   [PMID:  15599172 ]

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