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Hemodynamic and respiratory changes during lung recruitment and descending optimal positive end-expiratory pressure titration in patients with acute respiratory distress syndrome.
Crit Care Med. 2007 Mar; 35(3):787-93.CC

Abstract

OBJECTIVES

To investigate respiratory and hemodynamic changes during lung recruitment and descending optimal positive end-expiratory pressure (PEEP) titration.

DESIGN

Prospective auto-control clinical trial.

SETTING

Adult general intensive care unit in a university hospital.

PATIENTS

Eighteen patients with acute respiratory distress syndrome.

INTERVENTIONS

Following baseline measurements (T0), PEEP was set at 26 cm H2O and lung recruitment was performed (40/40-maneuver). Then tidal volume was set at 4 mL/kg (T26R) and PEEP was lowered by 2 cm H2O in every 4 mins. Optimal PEEP was defined at 2 cm H2O above the PEEP where Pao2 dropped by > 10%. After setting the optimal PEEP, the 40/40-maneuver was repeated and tidal volume set at 6 mL/kg (T(end)).

MEASUREMENTS AND MAIN RESULTS

Arterial blood gas analysis was done every 4 mins and hemodynamic measurements every 8 mins until T(end), then in 30 (T30) and 60 (T60) mins. The Pao2 increased from T0 to T(end) (203 +/- 108 vs. 322 +/- 101 mm Hg, p < .001), but the extravascular lung water (EVLW) did not change significantly. Cardiac index (CI) and the intrathoracic blood volume (ITBV) decreased from T0 to T26R (CI, 3.90 +/- 1.04 vs. 3.62 +/- 0.91 L/min/m2, p < .05; ITBVI, 832 +/- 205 vs. 795 +/- 188 m/m2, p < .05). There was a positive correlation between CI and ITBVI (r = .699, p < .01), a negative correlation between CI and central venous pressure (r = -.294, p < .01), and no correlation between CI and mean arterial pressure (MAP).

CONCLUSIONS

Following lung recruitment and descending optimal PEEP titration, the Pao2 improves significantly, without any change in the EVLW up to 1 hr. This suggests a decrease in atelectasis as a result of recruitment rather than a reduction of EVLW. There is a significant change in CI during the maneuver, but neither central venous pressure, heart rate, nor MAP can reflect these changes.

Authors+Show Affiliations

Department of Anaesthesia and Intensive Therapy, University of Pécs, Hungary.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17255855

Citation

Toth, Ildiko, et al. "Hemodynamic and Respiratory Changes During Lung Recruitment and Descending Optimal Positive End-expiratory Pressure Titration in Patients With Acute Respiratory Distress Syndrome." Critical Care Medicine, vol. 35, no. 3, 2007, pp. 787-93.
Toth I, Leiner T, Mikor A, et al. Hemodynamic and respiratory changes during lung recruitment and descending optimal positive end-expiratory pressure titration in patients with acute respiratory distress syndrome. Crit Care Med. 2007;35(3):787-93.
Toth, I., Leiner, T., Mikor, A., Szakmany, T., Bogar, L., & Molnar, Z. (2007). Hemodynamic and respiratory changes during lung recruitment and descending optimal positive end-expiratory pressure titration in patients with acute respiratory distress syndrome. Critical Care Medicine, 35(3), 787-93.
Toth I, et al. Hemodynamic and Respiratory Changes During Lung Recruitment and Descending Optimal Positive End-expiratory Pressure Titration in Patients With Acute Respiratory Distress Syndrome. Crit Care Med. 2007;35(3):787-93. PubMed PMID: 17255855.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemodynamic and respiratory changes during lung recruitment and descending optimal positive end-expiratory pressure titration in patients with acute respiratory distress syndrome. AU - Toth,Ildiko, AU - Leiner,Tamas, AU - Mikor,Andras, AU - Szakmany,Tamas, AU - Bogar,Lajos, AU - Molnar,Zsolt, PY - 2007/1/27/pubmed PY - 2007/5/3/medline PY - 2007/1/27/entrez SP - 787 EP - 93 JF - Critical care medicine JO - Crit. Care Med. VL - 35 IS - 3 N2 - OBJECTIVES: To investigate respiratory and hemodynamic changes during lung recruitment and descending optimal positive end-expiratory pressure (PEEP) titration. DESIGN: Prospective auto-control clinical trial. SETTING: Adult general intensive care unit in a university hospital. PATIENTS: Eighteen patients with acute respiratory distress syndrome. INTERVENTIONS: Following baseline measurements (T0), PEEP was set at 26 cm H2O and lung recruitment was performed (40/40-maneuver). Then tidal volume was set at 4 mL/kg (T26R) and PEEP was lowered by 2 cm H2O in every 4 mins. Optimal PEEP was defined at 2 cm H2O above the PEEP where Pao2 dropped by > 10%. After setting the optimal PEEP, the 40/40-maneuver was repeated and tidal volume set at 6 mL/kg (T(end)). MEASUREMENTS AND MAIN RESULTS: Arterial blood gas analysis was done every 4 mins and hemodynamic measurements every 8 mins until T(end), then in 30 (T30) and 60 (T60) mins. The Pao2 increased from T0 to T(end) (203 +/- 108 vs. 322 +/- 101 mm Hg, p < .001), but the extravascular lung water (EVLW) did not change significantly. Cardiac index (CI) and the intrathoracic blood volume (ITBV) decreased from T0 to T26R (CI, 3.90 +/- 1.04 vs. 3.62 +/- 0.91 L/min/m2, p < .05; ITBVI, 832 +/- 205 vs. 795 +/- 188 m/m2, p < .05). There was a positive correlation between CI and ITBVI (r = .699, p < .01), a negative correlation between CI and central venous pressure (r = -.294, p < .01), and no correlation between CI and mean arterial pressure (MAP). CONCLUSIONS: Following lung recruitment and descending optimal PEEP titration, the Pao2 improves significantly, without any change in the EVLW up to 1 hr. This suggests a decrease in atelectasis as a result of recruitment rather than a reduction of EVLW. There is a significant change in CI during the maneuver, but neither central venous pressure, heart rate, nor MAP can reflect these changes. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/17255855/Hemodynamic_and_respiratory_changes_during_lung_recruitment_and_descending_optimal_positive_end_expiratory_pressure_titration_in_patients_with_acute_respiratory_distress_syndrome_ L2 - https://dx.doi.org/10.1097/01.CCM.0000257330.54882.BE DB - PRIME DP - Unbound Medicine ER -