Document Detail


Respiratory controversies in the critical care setting. Do the NIH ARDS Clinical Trials Network PEEP/FIO2 tables provide the best evidence-based guide to balancing PEEP and FIO2 settings in adults?
MedLine Citation:
PMID:  17417980     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Positive end-expiratory pressure (PEEP) and inspired oxygen fraction (F(IO(2))) are the primary means of improving P(aO(2)) during mechanical ventilation. Patients with acute respiratory distress syndrome (ARDS) typically present with a large intrapulmonary shunt, which makes even high F(IO(2)) ineffective in improving P(aO(2)). PEEP decreases intrapulmonary shunt by recruiting collapsed alveoli, but PEEP is associated with important adverse effects, whereas prolonged exposure to high F(IO(2)) may cause oxidative lung injury. The improved survival found in the National Institutes of Health's ARDS Network low-tidal-volume study may suggest that their PEEP/F(IO(2)) titration tables represent the best method for adjusting these variables. Based upon an extensive literature review of PEEP and respiratory system mechanics in ARDS, we conclude that: (1) for most patients the therapeutic range of PEEP is relatively narrow, so the ARDS Network PEEP/F(IO(2)) strategy is reasonable and supported by high-level evidence, (2) how best to adjust PEEP to prevent or ameliorate ventilator-associated lung injury is unknown and still under investigation, and (3) in a small subset of patients with severe lung injury and/or abnormal chest-wall compliance, highly individualized titration of PEEP, based upon the respiratory-system pressure-volume curve, PEEP/tidal-volume titration grids, or a recruitment maneuver and a PEEP decrement trial is a reasonable alternative.
Authors:
Richard H Kallet; Richard D Branson
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Respiratory care     Volume:  52     ISSN:  0020-1324     ISO Abbreviation:  Respir Care     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-04-09     Completed Date:  2007-06-19     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  461-75; discussion 475-7     Citation Subset:  IM    
Affiliation:
Cardiovascular Research Institute, Respiratory Care Services, Department of Anesthesia, San Francisco General Hospital, University of California, San Francisco, CA, USA. rkallet@sfghsom.ucsf.edu
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MeSH Terms
Descriptor/Qualifier:
Clinical Trials as Topic
Evidence-Based Medicine
Humans
National Institutes of Health (U.S.)
Positive-Pressure Respiration*
Pulmonary Atelectasis / prevention & control
Pulmonary Gas Exchange*
Respiratory Distress Syndrome, Adult / therapy
Respiratory Mechanics
United States

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


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