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Effects of sustained inflation and postinflation positive end-expiratory pressure in acute respiratory distress syndrome: focusing on pulmonary and extrapulmonary forms.
Crit Care Med. 2003 Mar; 31(3):738-44.CC

Abstract

OBJECTIVE

To investigate whether the response to sustained inflation and postinflation positive end-expiratory pressure varies between acute respiratory distress syndrome with pulmonary (ARDS(exp)) and extrapulmonary origin (ARDS(exp)).

DESIGN

Prospective clinical study.

SETTING

Multidisciplinary intensive care unit in a university hospital.

PATIENTS

A total of 11 patients with ARDS and 13 patients with ARDS.

INTERVENTIONS

A 7 ml/kg tidal volume, 12-15 breaths/min respiratory rate, and an inspiratory/expiratory ratio of 1:2 was used during baseline ventilation. Positive end-expiratory pressure levels were set according to the decision of the primary physician. Sustained inflation was performed by 45 cm H2O continuous positive airway pressure for 30 secs. Postinflation positive end-expiratory pressure was titrated decrementally, starting from a level of 20 cm H2O to keep the peripheral oxygen saturation between 92% and 95%. Fio2 was decreased, and baseline tidal volume, respiratory rate, inspiratory/expiratory ratio were maintained unchanged throughout the study period.

MEASUREMENTS AND MAIN RESULTS

Blood gas, airway pressure, and hemodynamic measurements were performed at the following time points: at baseline and at 15 mins, 1 hr, 4 hrs, and 6 hrs after sustained inflation. After sustained inflation, the Pao2/Fio2 ratio improved in all of the patients both in ARDS(p) and ARDS(exp). However, the Pao2/Fio2 ratio increased to >200 in four ARDS(p) patients (36%) and in seven ARDS(p) patients (54%). In two of those ARDS patients, the Pao2/Fio2 ratio was found to be <200, whereas none of the ARDS(p) patients revealed Pao2/Fio2 ratios of <200 at the 6-hr measurement. Postinflation positive end-expiratory pressure levels were set at 16.7 +/- 2.3 cm H O in ARDS(p) and 15.6 +/- 2.5 cm H2O in ARDS. The change in Pao /Fio ratios was found statistically significant in patients with ARDS(p) (p =.0001) and with ARDS(p) (p =.008). Respiratory system compliance increased in ARDS patients (p =.02), whereas the change in ARDS was not statistically significant.

CONCLUSIONS

Sustained inflation followed by high levels of postinflation positive end-expiratory pressure provided an increase in respiratory system compliance in ARDS; however, arterial oxygenation improved in both ARDS forms.

Authors+Show Affiliations

Anesthesiology Department, Istanbul Medical Faculty, Turkey.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

12626977

Citation

Tugrul, Simru, et al. "Effects of Sustained Inflation and Postinflation Positive End-expiratory Pressure in Acute Respiratory Distress Syndrome: Focusing On Pulmonary and Extrapulmonary Forms." Critical Care Medicine, vol. 31, no. 3, 2003, pp. 738-44.
Tugrul S, Akinci O, Ozcan PE, et al. Effects of sustained inflation and postinflation positive end-expiratory pressure in acute respiratory distress syndrome: focusing on pulmonary and extrapulmonary forms. Crit Care Med. 2003;31(3):738-44.
Tugrul, S., Akinci, O., Ozcan, P. E., Ince, S., Esen, F., Telci, L., Akpir, K., & Cakar, N. (2003). Effects of sustained inflation and postinflation positive end-expiratory pressure in acute respiratory distress syndrome: focusing on pulmonary and extrapulmonary forms. Critical Care Medicine, 31(3), 738-44.
Tugrul S, et al. Effects of Sustained Inflation and Postinflation Positive End-expiratory Pressure in Acute Respiratory Distress Syndrome: Focusing On Pulmonary and Extrapulmonary Forms. Crit Care Med. 2003;31(3):738-44. PubMed PMID: 12626977.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of sustained inflation and postinflation positive end-expiratory pressure in acute respiratory distress syndrome: focusing on pulmonary and extrapulmonary forms. AU - Tugrul,Simru, AU - Akinci,Ozkan, AU - Ozcan,Perihan E, AU - Ince,Sibel, AU - Esen,Figen, AU - Telci,Lutfi, AU - Akpir,Kutay, AU - Cakar,Nahit, PY - 2003/3/11/pubmed PY - 2003/4/12/medline PY - 2003/3/11/entrez SP - 738 EP - 44 JF - Critical care medicine JO - Crit. Care Med. VL - 31 IS - 3 N2 - OBJECTIVE: To investigate whether the response to sustained inflation and postinflation positive end-expiratory pressure varies between acute respiratory distress syndrome with pulmonary (ARDS(exp)) and extrapulmonary origin (ARDS(exp)). DESIGN: Prospective clinical study. SETTING: Multidisciplinary intensive care unit in a university hospital. PATIENTS: A total of 11 patients with ARDS and 13 patients with ARDS. INTERVENTIONS: A 7 ml/kg tidal volume, 12-15 breaths/min respiratory rate, and an inspiratory/expiratory ratio of 1:2 was used during baseline ventilation. Positive end-expiratory pressure levels were set according to the decision of the primary physician. Sustained inflation was performed by 45 cm H2O continuous positive airway pressure for 30 secs. Postinflation positive end-expiratory pressure was titrated decrementally, starting from a level of 20 cm H2O to keep the peripheral oxygen saturation between 92% and 95%. Fio2 was decreased, and baseline tidal volume, respiratory rate, inspiratory/expiratory ratio were maintained unchanged throughout the study period. MEASUREMENTS AND MAIN RESULTS: Blood gas, airway pressure, and hemodynamic measurements were performed at the following time points: at baseline and at 15 mins, 1 hr, 4 hrs, and 6 hrs after sustained inflation. After sustained inflation, the Pao2/Fio2 ratio improved in all of the patients both in ARDS(p) and ARDS(exp). However, the Pao2/Fio2 ratio increased to >200 in four ARDS(p) patients (36%) and in seven ARDS(p) patients (54%). In two of those ARDS patients, the Pao2/Fio2 ratio was found to be <200, whereas none of the ARDS(p) patients revealed Pao2/Fio2 ratios of <200 at the 6-hr measurement. Postinflation positive end-expiratory pressure levels were set at 16.7 +/- 2.3 cm H O in ARDS(p) and 15.6 +/- 2.5 cm H2O in ARDS. The change in Pao /Fio ratios was found statistically significant in patients with ARDS(p) (p =.0001) and with ARDS(p) (p =.008). Respiratory system compliance increased in ARDS patients (p =.02), whereas the change in ARDS was not statistically significant. CONCLUSIONS: Sustained inflation followed by high levels of postinflation positive end-expiratory pressure provided an increase in respiratory system compliance in ARDS; however, arterial oxygenation improved in both ARDS forms. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/12626977/Effects_of_sustained_inflation_and_postinflation_positive_end_expiratory_pressure_in_acute_respiratory_distress_syndrome:_focusing_on_pulmonary_and_extrapulmonary_forms_ L2 - https://dx.doi.org/10.1097/01.CCM.0000053554.76355.72 DB - PRIME DP - Unbound Medicine ER -