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Effects of different levels of end-expiratory positive pressure on lung recruitment and protection in patients with acute respiratory distress syndrome.
Chin Med J (Engl). 2008 Nov 20; 121(22):2218-23.CM

Abstract

BACKGROUND

It is still controversial as to the implementation of higher positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS). This study was conducted to compare the lower and higher PEEP in patients with ARDS ventilated with low tidal volume, to investigate the relationship between the recruited lung volume by higher PEEP and relevant independent variables and to provide a bedside estimate of the percentage of potentially recruitable lung by higher PEEP.

METHODS

Twenty-four patients with ARDS were studied. A lung recruiting maneuver was performed, then each patient was ventilated with PEEP of 8 cmH(2)O for 4 hours and subsequently with PEEP of 16 cmH(2)O for 4 hours. At the end of each PEEP level period, gas exchange, hemodynamic data, lung mechanics, stress index "b" of the dynamic pressure-time curve, intrinsic PEEP and recruited volume by PEEP were measured.

RESULTS

Fourteen patients were recruiters whose alveolar recruited volumes induced by PEEP 16 cmH(2)O were (425 +/- 65) ml and 10 patients were non-recruiters. Compared with the PEEP 8 cmH(2)O period, after the application of the PEEP 16 cmH(2)O, the PaO(2)/FiO(2) ratio and static lung compliance both remained unchanged in non-recruiters, whereas they increased significantly in recruiters. Changes in PaO(2)/FiO(2) and static lung compliance after PEEP increase were independently associated with the alveolar recruitment. Analyzing the relationship between recruiting maneuver (RM)-induced change in end-expiratory lung volume and the alveolar recruitment induced by PEEP, we found a notable correlation.

CONCLUSIONS

The results of this study indicated that the potential for alveolar recruitment might vary among the ARDS population and the higher PEEP levels should be limited to recruiters. Improving in PaO(2)/FiO(2), static lung compliance after PEEP increase and the shape of the pressure-time curve could be helpful for PEEP application.

Authors+Show Affiliations

Department of Respiratory Diseases, Nanjing General Hospital of Nanjing Military Command, PLA, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

19080320

Citation

Guo, Feng-mei, et al. "Effects of Different Levels of End-expiratory Positive Pressure On Lung Recruitment and Protection in Patients With Acute Respiratory Distress Syndrome." Chinese Medical Journal, vol. 121, no. 22, 2008, pp. 2218-23.
Guo FM, Ding JJ, Su X, et al. Effects of different levels of end-expiratory positive pressure on lung recruitment and protection in patients with acute respiratory distress syndrome. Chin Med J (Engl). 2008;121(22):2218-23.
Guo, F. M., Ding, J. J., Su, X., Xu, H. Y., & Shi, Y. (2008). Effects of different levels of end-expiratory positive pressure on lung recruitment and protection in patients with acute respiratory distress syndrome. Chinese Medical Journal, 121(22), 2218-23.
Guo FM, et al. Effects of Different Levels of End-expiratory Positive Pressure On Lung Recruitment and Protection in Patients With Acute Respiratory Distress Syndrome. Chin Med J (Engl). 2008 Nov 20;121(22):2218-23. PubMed PMID: 19080320.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of different levels of end-expiratory positive pressure on lung recruitment and protection in patients with acute respiratory distress syndrome. AU - Guo,Feng-mei, AU - Ding,Jing-jing, AU - Su,Xin, AU - Xu,Hui-ying, AU - Shi,Yi, PY - 2008/12/17/entrez PY - 2008/12/17/pubmed PY - 2009/3/27/medline SP - 2218 EP - 23 JF - Chinese medical journal JO - Chin Med J (Engl) VL - 121 IS - 22 N2 - BACKGROUND: It is still controversial as to the implementation of higher positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS). This study was conducted to compare the lower and higher PEEP in patients with ARDS ventilated with low tidal volume, to investigate the relationship between the recruited lung volume by higher PEEP and relevant independent variables and to provide a bedside estimate of the percentage of potentially recruitable lung by higher PEEP. METHODS: Twenty-four patients with ARDS were studied. A lung recruiting maneuver was performed, then each patient was ventilated with PEEP of 8 cmH(2)O for 4 hours and subsequently with PEEP of 16 cmH(2)O for 4 hours. At the end of each PEEP level period, gas exchange, hemodynamic data, lung mechanics, stress index "b" of the dynamic pressure-time curve, intrinsic PEEP and recruited volume by PEEP were measured. RESULTS: Fourteen patients were recruiters whose alveolar recruited volumes induced by PEEP 16 cmH(2)O were (425 +/- 65) ml and 10 patients were non-recruiters. Compared with the PEEP 8 cmH(2)O period, after the application of the PEEP 16 cmH(2)O, the PaO(2)/FiO(2) ratio and static lung compliance both remained unchanged in non-recruiters, whereas they increased significantly in recruiters. Changes in PaO(2)/FiO(2) and static lung compliance after PEEP increase were independently associated with the alveolar recruitment. Analyzing the relationship between recruiting maneuver (RM)-induced change in end-expiratory lung volume and the alveolar recruitment induced by PEEP, we found a notable correlation. CONCLUSIONS: The results of this study indicated that the potential for alveolar recruitment might vary among the ARDS population and the higher PEEP levels should be limited to recruiters. Improving in PaO(2)/FiO(2), static lung compliance after PEEP increase and the shape of the pressure-time curve could be helpful for PEEP application. SN - 2542-5641 UR - https://www.unboundmedicine.com/medline/citation/19080320/Effects_of_different_levels_of_end_expiratory_positive_pressure_on_lung_recruitment_and_protection_in_patients_with_acute_respiratory_distress_syndrome_ L2 - https://Insights.ovid.com/pubmed?pmid=19080320 DB - PRIME DP - Unbound Medicine ER -