| A comparison of methods to identify open-lung PEEP. | |
| | |
MedLine Citation:
|
PMID: 19183951 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
PURPOSE: Many methods exist in the literature for identifying PEEP to set in ARDS patients following a lung recruitment maneuver (RM). We compared ten published parameters for setting PEEP following a RM. METHODS: Lung injury was induced by bilateral lung lavage in 14 female Dorset sheep, yielding a PaO(2) 100-150 mmHg at F(I)O(2) 1.0 and PEEP 5 cmH(2)O. A quasi-static P-V curve was then performed using the supersyringe method; PEEP was set to 20 cmH(2)O and a RM performed with pressure control ventilation (inspiratory pressure set to 40-50 cmH(2)O), until PaO(2) + PaCO(2) > 400 mmHg. Following the RM, a decremental PEEP trial was performed. The PEEP was decreased in 1 cmH(2)O steps every 5 min until 15 cmH(2)O was reached. Parameters measured during the decremental PEEP trial were compared with parameters obtained from the P-V curve. RESULTS: For setting PEEP, maximum dynamic tidal respiratory compliance, maximum PaO(2), maximum PaO(2) + PaCO(2), and minimum shunt calculated during the decremental PEEP trial, and the lower Pflex and point of maximal compliance increase on the inflation limb of the P-V curve (Pmci,i) were statistically indistinguishable. The PEEP value obtained using the deflation upper Pflex and the point of maximal compliance decrease on the deflation limb were significantly higher, and the true inflection point on the inflation limb and minimum PaCO(2) were significantly lower than the other variables. CONCLUSION: In this animal model of ARDS, dynamic tidal respiratory compliance, maximum PaO(2), maximum PaO(2) + PaCO(2), minimum shunt, inflation lower Pflex and Pmci,i yield similar values for PEEP following a recruitment maneuver. |
| | |
Authors:
|
Maria Paula Caramez; Robert M Kacmarek; Mohamed Helmy; Eriko Miyoshi; Atul Malhotra; Marcelo B P Amato; R Scott Harris |
Publication Detail:
|
Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Date: 2009-01-31 |
Journal Detail:
|
Title: Intensive care medicine Volume: 35 ISSN: 1432-1238 ISO Abbreviation: Intensive Care Med Publication Date: 2009 Apr |
Date Detail:
|
Created Date: 2009-03-18 Completed Date: 2009-07-13 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: United States |
Other Details:
|
Languages: eng Pagination: 740-7 Citation Subset: IM |
Affiliation:
|
Department of Anesthesia and Critical Care, and Respiratory Care, Massachusetts General Hospital, Boston, MA, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Animals Biomechanics Blood Gas Analysis Exhalation Female Irrigation / methods Lung Injury / therapy* Positive-Pressure Respiration* Sheep Tidal Volume |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Determining small intestinal transit time and pathomorphology in critically ill patients using video...
Next Document: Thenar oxygen saturation measured by near infrared spectroscopy as a noninvasive predictor of low ce...