Document Detail


Respective effects of end-expiratory and end-inspiratory pressures on alveolar recruitment in acute lung injury.
MedLine Citation:
PMID:  12544999     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: A low tidal volume can induce alveolar derecruitment in patients with acute lung injury. This study was undertaken to evaluate whether this resulted mainly from the decrease in tidal volume or from the reduction in end-inspiratory plateau pressure and whether there is any benefit in raising the level of positive end-expiratory pressure (PEEP) while plateau pressure is kept constant. DESIGN: Prospective crossover study. SETTING: Medical intensive care unit of a university teaching hospital. PATIENTS: Fifteen adult patients ventilated for acute lung injury (PaO2/FiO2, 158 +/- 34 mm Hg; lung injury score, 2.7 +/- 0.6). INTERVENTIONS: Three combinations were tested: PEEP at the lower inflection point with 6 mL/kg tidal volume, PEEP at the lower inflection point with 10 mL/kg tidal volume, and high PEEP with tidal volume at 6 mL/kg, keeping the plateau pressure similar to the preceding condition. MEASUREMENTS AND MAIN RESULTS: Pressure-volume curves at zero PEEP and at set PEEP were recorded, and recruitment was calculated as the volume difference between both curves for pressures ranging from 15 to 30 cm H2O. Arterial blood gases were measured for all patients. For a similar PEEP at the lower inflection point (10 +/- 3 cm H2O), tidal volume reduction (10 to 6 mL/kg) led to a significant derecruitment. A low tidal volume (6 mL/kg) with high PEEP (14 +/- 3 cm H2O), however, induced a significantly greater recruitment and a higher Pao than the two other strategies. CONCLUSION: At a given plateau pressure (i.e., similar end-inspiratory distension), lowering tidal volume and increasing PEEP increase recruitment and PaO2.
Authors:
Jean-Christophe Richard; Laurent Brochard; Philippe Vandelet; Lucie Breton; Salvatore M Maggiore; Bjorn Jonson; Karine Clabault; Jacques Leroy; Guy Bonmarchand
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  31     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2003-01-24     Completed Date:  2003-02-14     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  89-92     Citation Subset:  AIM; IM    
Affiliation:
Medical Intensive Care Unit, Rouen University Hospital-Charles Nicolle, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cross-Over Studies
Female
Hemodynamics
Humans
Male
Middle Aged
Positive-Pressure Respiration / adverse effects,  methods*
Prospective Studies
Pulmonary Alveoli / physiopathology*
Respiratory Distress Syndrome, Adult / physiopathology,  therapy*
Respiratory Mechanics
Statistics, Nonparametric
Tidal Volume
Comments/Corrections
Comment In:
Crit Care Med. 2003 Jan;31(1):318-20   [PMID:  12545042 ]
Erratum In:
Crit Care Med. 2003 Apr;31(4):1296

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


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