Document Detail

A decremental PEEP trial for determining open-lung PEEP in a rabbit model of acute lung injury.
MedLine Citation:
PMID:  18293413     Owner:  NLM     Status:  MEDLINE    
A positive end-expiratory pressure (PEEP) above the lower inflection point (LIP) of the pressure-volume curve has been thought necessary to maintain recruited lung volume in acute lung injury (ALI). We used a strategy to identify the level of open-lung PEEP (OLP) by detecting the maximum tidal compliance during a decremental PEEP trial (DPT). We performed a randomized controlled study to compare the effect of the OLP to PEEP above LIP and zero PEEP on pulmonary mechanics, gas exchange, hemodynamic change, and lung injury in 26 rabbits with ALI. After recruitment maneuver, the lavage-injured rabbits received DPTs to identify the OLP. Animals were randomized to receive volume controlled ventilation with either: (a) PEEP = 0 cm H2O (ZEEP); (b) PEEP = 2 cm H2O above OLP (OLP + 2); or (c) PEEP = 2 cm H2O above LIP (LIP + 2). Peak inspiratory pressure and mean airway pressure were recorded and arterial blood gases were analyzed every 30 min. Mean blood pressure and heart rate were monitored continuously. Lung injury severity was assessed by lung wet/dry weight ratio. Animals in OLP + 2 group had less lung injury as well as relatively better compliance, more stable pH, and less hypercapnia compared to the LIP + 2 and ZEEP groups. We concluded that setting PEEP according to the OLP identified by DPTs is an effective method to attenuate lung injury. This strategy could be used as an indicator for optimal PEEP. The approach is simple and noninvasive and may be of clinical interest.
Yi-Ming Hua; Shao-Hung Lien; Tao-Yuan Liu; Chuen-Ming Lee; Yeong-Seng Yuh
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatric pulmonology     Volume:  43     ISSN:  1099-0496     ISO Abbreviation:  Pediatr. Pulmonol.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-04     Completed Date:  2008-06-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8510590     Medline TA:  Pediatr Pulmonol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  371-80     Citation Subset:  IM    
Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
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MeSH Terms
Blood Pressure
Disease Models, Animal
Heart Rate
Hydrogen-Ion Concentration
Lung / physiopathology
Lung Compliance
Monitoring, Physiologic
Positive-Pressure Respiration / methods*
Pulmonary Gas Exchange
Random Allocation
Respiratory Distress Syndrome, Adult / therapy*
Respiratory Mechanics
Severity of Illness Index
Tidal Volume
Total Lung Capacity

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

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