| Set positive end-expiratory pressure during protective ventilation affects lung injury. | |
| | |
MedLine Citation:
|
PMID: 12218536 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: The most appropriate method of determining positive end-expiratory pressure (PEEP) level during a lung protective ventilatory strategy has not been established. METHODS: In a lavage-injured sheep acute respiratory distress syndrome model, the authors compared the effects of three approaches to determining PEEP level after a recruitment maneuver: (1) 2 cm H(2)O above the lower inflection point on the inflation pressure-volume curve, (2) at the point of maximum curvature on the deflation pressure-volume curve, and (3) at the PEEP level that maintained target arterial oxygen partial pressure at a fraction of inspired oxygen of 0.5. RESULTS: Positive end-expiratory pressure set 2 cm H(2)O above the lower inflection point resulted in the least injury over the course of the study. PEEP based on adequate arterial oxygen partial pressure/fraction of inspired oxygen ratios had to be increased over time and resulted in higher mRNA levels for interleukin-8 and interleukin-1beta and greater tissue inflammation when compared with the other approaches. PEEP at the point of maximum curvature could not maintain eucapneia even at an increased ventilatory rate. CONCLUSION: Although generating higher plateau pressures, PEEP levels based on pressure-volume curve analysis were more effective in maintaining gas exchange and minimizing injury than PEEP based on adequate oxygenation. PEEP at 2 cm H(2)O above the lower inflection point was most effective. |
| | |
Authors:
|
Muneyuki Takeuchi; Sven Goddon; Marisa Dolhnikoff; Motomu Shimaoka; Dean Hess; Marcelo B P Amato; Robert M Kacmarek |
Related Documents
:
|
11126266 - Ventilator-induced lung injury leads to loss of alveolar and systemic compartmentalizat... 11176166 - Gastric intramucosal pco2 and ph variability in ventilated critically ill patients. 17242096 - The pulmonary and hemodynamic effects of two different recruitment maneuvers after card... 6991176 - Comparison of haemodynamic responses to positive-end-expiratory ventilation and pericar... 10677156 - Pressure drop, shear stress, and activation of leukocytes during cardiopulmonary bypass... 8413856 - Failure of intravenous pentagastrin challenge to induce panic-like effects in rhesus mo... |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
|
Title: Anesthesiology Volume: 97 ISSN: 0003-3022 ISO Abbreviation: Anesthesiology Publication Date: 2002 Sep |
Date Detail:
|
Created Date: 2002-09-09 Completed Date: 2002-09-24 Revised Date: 2008-11-21 |
Medline Journal Info:
|
Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: United States |
Other Details:
|
Languages: eng Pagination: 682-92 Citation Subset: AIM; IM |
Affiliation:
|
Department of Anesthesia/Respiratory Care, Massachusetts General Hospital, The Center for Blood Research, Boston 02114, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Air Pressure Animals Hemodynamics / physiology Histocytochemistry Irrigation Lung / pathology, physiopathology Lung Injury* Lung Volume Measurements Oxygen / blood Positive-Pressure Respiration* Respiration, Artificial Respiratory Distress Syndrome, Adult / physiopathology Respiratory Mechanics / physiology Reverse Transcriptase Polymerase Chain Reaction Sheep Vascular Resistance / physiology |
| Chemical | |
Reg. No./Substance:
|
7782-44-7/Oxygen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Changes in regional ventilation after autologous blood clot pulmonary embolism.
Next Document: Dexmedetomidine increases the cocaine seizure threshold in rats.