Tags

Type your tag names separated by a space and hit enter

[Effect of lung stress index upon titration of positive end-expiratory pressure at post-recruitment in patients with acute respiratory distress syndrome].
Zhonghua Yi Xue Za Zhi. 2009 Oct 27; 89(39):2739-43.ZY

Abstract

OBJECTIVE

To investigate the relationship of stress index and positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS) and to determine the relationship of stress index, lung recruitment, oxygenation and respiration mechanics.

METHODS

Fourteen ARDS patients were enrolled. During volume control ventilation with constant inspiratory flow, the pressure-time (P-t) curve was fitted to a power equation: P = a x time(b) + c, where coefficient b (stress index) describes the shape of curve: b = 1, straight curve; b < 1, progressive increase in slope; and b > 1, progressive decrease in slope. Positive end-expiratory pressure (PEEP) was set to obtain b value between 0.9 and 1.1 after application of a recruiting maneuver (RM). PEEP was changed to obtain 0.6 < b < 0.8 and 1.1 < b < 1.3. The sequence of experimental conditions was random. Recruited volume (RV) was measured by static pressure-volume curve method. Hemodynamics, pulmonary mechanics and gas exchange were observed simultaneously.

RESULTS

PEEP at b < 1, b = 1 and b > 1 were (8.3 +/- 1.5) cm H2O, (15.0 +/- 1.9) cm H2O and (18.4 +/- 1.9) cm H2O respectively with a significant difference (P < 0.001). At b = 1 and b > 1, the partial arterial oxygen tension (PaO2/FiO2) [(350 +/- 113) mm Hg, (338 +/- 124 mm Hg)] were higher than that [165 +/- 60) mm Hg] of pre-RM (P < 0.05). the plateau pressure (Pplat) at b = 1 [(29 +/- 4) cm H2O] and b > 1 [(33 +/- 7) cm H2O] post-RM were significantly higher than that at b < 1 [(22 +/- 4) cm H2O] (P < 0.05); the Pplat at b > 1 was higher than that [(25 +/- 16) cm H2O] pre-RM (P < 0.05). Compared with the static pulmonary compliance (Cst) at b = 1 [(39 +/- 11) ml/cm H2O], Cst at b > 1 [(26 +/- 7) ml/cm H2O] decreased significantly (P < 0.05). The RV at b = 1 and b > 1 [(402 +/- 204) ml, (588 +/- 269) ml] were significantly higher than that at pre-RM and b < 1 [(136 +/- 111) ml, (175 +/- 122) ml] (P < 0.05). At pre-RM, b < 1, b = 1 and b > 1, HR, mean arterial pressure (MAP) and lactate showed no significant difference (P > 0.05).

CONCLUSION

Stress index at post-RM can be an excellent method of PEEP titration for ARDS patients.

Authors+Show Affiliations

Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Clinical Medicine, Southeast University, Nanjing 210009, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article
Research Support, Non-U.S. Gov't

Language

chi

PubMed ID

20137593

Citation

Huang, Ying-Zi, et al. "[Effect of Lung Stress Index Upon Titration of Positive End-expiratory Pressure at Post-recruitment in Patients With Acute Respiratory Distress Syndrome]." Zhonghua Yi Xue Za Zhi, vol. 89, no. 39, 2009, pp. 2739-43.
Huang YZ, Yang Y, Liu SQ, et al. [Effect of lung stress index upon titration of positive end-expiratory pressure at post-recruitment in patients with acute respiratory distress syndrome]. Zhonghua Yi Xue Za Zhi. 2009;89(39):2739-43.
Huang, Y. Z., Yang, Y., Liu, S. Q., Yang, C. S., & Qiu, H. B. (2009). [Effect of lung stress index upon titration of positive end-expiratory pressure at post-recruitment in patients with acute respiratory distress syndrome]. Zhonghua Yi Xue Za Zhi, 89(39), 2739-43.
Huang YZ, et al. [Effect of Lung Stress Index Upon Titration of Positive End-expiratory Pressure at Post-recruitment in Patients With Acute Respiratory Distress Syndrome]. Zhonghua Yi Xue Za Zhi. 2009 Oct 27;89(39):2739-43. PubMed PMID: 20137593.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Effect of lung stress index upon titration of positive end-expiratory pressure at post-recruitment in patients with acute respiratory distress syndrome]. AU - Huang,Ying-Zi, AU - Yang,Yi, AU - Liu,Song-Qiao, AU - Yang,Cong-Shan, AU - Qiu,Hai-Bo, PY - 2010/2/9/entrez PY - 2010/2/9/pubmed PY - 2010/6/9/medline SP - 2739 EP - 43 JF - Zhonghua yi xue za zhi JO - Zhonghua Yi Xue Za Zhi VL - 89 IS - 39 N2 - OBJECTIVE: To investigate the relationship of stress index and positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS) and to determine the relationship of stress index, lung recruitment, oxygenation and respiration mechanics. METHODS: Fourteen ARDS patients were enrolled. During volume control ventilation with constant inspiratory flow, the pressure-time (P-t) curve was fitted to a power equation: P = a x time(b) + c, where coefficient b (stress index) describes the shape of curve: b = 1, straight curve; b < 1, progressive increase in slope; and b > 1, progressive decrease in slope. Positive end-expiratory pressure (PEEP) was set to obtain b value between 0.9 and 1.1 after application of a recruiting maneuver (RM). PEEP was changed to obtain 0.6 < b < 0.8 and 1.1 < b < 1.3. The sequence of experimental conditions was random. Recruited volume (RV) was measured by static pressure-volume curve method. Hemodynamics, pulmonary mechanics and gas exchange were observed simultaneously. RESULTS: PEEP at b < 1, b = 1 and b > 1 were (8.3 +/- 1.5) cm H2O, (15.0 +/- 1.9) cm H2O and (18.4 +/- 1.9) cm H2O respectively with a significant difference (P < 0.001). At b = 1 and b > 1, the partial arterial oxygen tension (PaO2/FiO2) [(350 +/- 113) mm Hg, (338 +/- 124 mm Hg)] were higher than that [165 +/- 60) mm Hg] of pre-RM (P < 0.05). the plateau pressure (Pplat) at b = 1 [(29 +/- 4) cm H2O] and b > 1 [(33 +/- 7) cm H2O] post-RM were significantly higher than that at b < 1 [(22 +/- 4) cm H2O] (P < 0.05); the Pplat at b > 1 was higher than that [(25 +/- 16) cm H2O] pre-RM (P < 0.05). Compared with the static pulmonary compliance (Cst) at b = 1 [(39 +/- 11) ml/cm H2O], Cst at b > 1 [(26 +/- 7) ml/cm H2O] decreased significantly (P < 0.05). The RV at b = 1 and b > 1 [(402 +/- 204) ml, (588 +/- 269) ml] were significantly higher than that at pre-RM and b < 1 [(136 +/- 111) ml, (175 +/- 122) ml] (P < 0.05). At pre-RM, b < 1, b = 1 and b > 1, HR, mean arterial pressure (MAP) and lactate showed no significant difference (P > 0.05). CONCLUSION: Stress index at post-RM can be an excellent method of PEEP titration for ARDS patients. SN - 0376-2491 UR - https://www.unboundmedicine.com/medline/citation/20137593/[Effect_of_lung_stress_index_upon_titration_of_positive_end_expiratory_pressure_at_post_recruitment_in_patients_with_acute_respiratory_distress_syndrome]_ L2 - http://journal.yiigle.com/LinkIn.do?linkin_type=pubmed&amp;issn=0376-2491&amp;year=2009&amp;vol=89&amp;issue=39&amp;fpage=2739 DB - PRIME DP - Unbound Medicine ER -