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Positive end-expiratory pressure lung recruitment: comparison between lower inflection point and ultrasound assessment.
MedLine Citation:
PMID:  23229578     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Maintenance of the open lung alveoli in the expiration on mechanical ventilation in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) remains challenging despite advances in lung imaging. The inspiratory lower inflection point (LIP) on the ventilator pressure-volume (P-V) curve estimates the required end-expiratory pressure for recruitment of alveolar consolidation. Alternatively, the end-expiratory pressure for recruitment of crater-like subpleural alveolar consolidation could be simply followed with ultrasound. These two methods for setting the ventilators positive end-expiratory pressure (PEEP) were compared. METHODS: The observational study in surgical/neurosurgical intensive care between October 2009 and November 2011 included 17 deeply sedated or relaxed patients. LIP was measured with continuous low-flow method, as a pressure in cmH(2)O. Expiratory levelling between lower border of subpleural consolidation and adjacent pleural line, which means lung recruitment, was followed with linear ultrasound probe. PEEP in cmH(2)O at which the levelling occurs was compared with LIP pressure. RESULTS: LIP pressure never exceeds the PEEP for recruitment of subpleural consolidations followed with ultrasound. A significant correlation (r = 0.839; p < 0.05) was found between two methods. CONCLUSIONS: In this study, positive end-expiratory pressures for recruitment of subpleural consolidations followed by ultrasound always exceed the pressures measured with LIP. Respecting this, ultrasound method could be the guide for PEEP lung recruitment.
Authors:
Bojan Rode; Marinko Vučić; Mladen Siranović; Ana Horvat; Helena Krolo; Mijo Kelečić; Aleksandar Gopčević
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-11
Journal Detail:
Title:  Wiener klinische Wochenschrift     Volume:  -     ISSN:  1613-7671     ISO Abbreviation:  Wien. Klin. Wochenschr.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  21620870R     Medline TA:  Wien Klin Wochenschr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Anaesthesiology and Intensive Care, University Hospital Center "Sisters of Mercy", Vinogradska 29, 10000, Zagreb, Croatia, bojan.rode@zg.t-com.hr.
Vernacular Title:
Bestimmung des für Recruitment der Lungen notwendigen end-exspiratorischen Drucks: Vergleich der Erhebung dieses Drucks durch Bestimmung des unteren Wendepunktes mit der Erfassung durch Ultraschall.
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