Document Detail

Set positive end-expiratory pressure during protective ventilation affects lung injury.
MedLine Citation:
PMID:  12218536     Owner:  NLM     Status:  MEDLINE    
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.
Muneyuki Takeuchi; Sven Goddon; Marisa Dolhnikoff; Motomu Shimaoka; Dean Hess; Marcelo B P Amato; Robert M Kacmarek
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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    
Department of Anesthesia/Respiratory Care, Massachusetts General Hospital, The Center for Blood Research, Boston 02114, USA.
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MeSH Terms
Air Pressure
Hemodynamics / physiology
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
Vascular Resistance / physiology
Reg. No./Substance:

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

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