ISSN:
1432-1238
Keywords:
Key words Positive end-expiratory pressure
;
Mechanical ventilation
;
Barotrauma prevention
;
Alveolar recruitment
;
Acute respiratory distress syndrome (ARDS)
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Objective: We wished to investigate whether volume recruitment maneuvers (VRMs) could improve alveolar recruitment and oxygenation in acute respiratory distress syndrome (ARDS) patients, ventilated at relatively low positive end-expiratory pressure (PEEP). Setting: General intensive care unit (ICU) located in a teaching hospital. Patients: 15 PEEP responder ARDS patients undergoing continuous positive pressure ventilation (CPPV) with sedation and muscle paralysis. Interventions: We identified a low (9.4 ± 3 cmH2O) and a high (16.0 ± 2 cmH2O) level of PEEP associated with target oxygenation values. Using a custom modified mechanical ventilator, we applied in random order three steps lasting 30 min: (1) CPPV at the low PEEP level (CPPV lo); (2) CPPV at the high PEEP level (CPPV hi); (3) CPPV at low PEEP with the superimposition of periodic VRMs (CPPV vrm). VRMs were performed twice a minute by increasing PEEP to the high level for two breaths. Each brace of two breaths was spaced 30 seconds from the preceding one. Measurements and results: We measured gas exchange, hemodynamics, respiratory mechanics, and the end expiratory lung volume (EELV). Compared to CPPVlo, CPPVvrm resulted in higher PaO2 (117.9 ± 40.6 vs 79.4 ± 13.6 mmHg, P 〈 0.01) and EELV (1.50 ± 0.62 vs 1.26 ± 0.50 l, P 〈 0.05), and in lower venous admixture (Qva/Qt) (0.42 ± 0.07 vs 0.48 ± 0.07, P 〈 0.01). During CPPVhi, we observed significantly higher PaO2 (139.3 ± 32.5 mmHg) and lower Qva/Qt (0.37 ± 0.08) compared to CPPVlo (P 〈 0.01) and to CPPVvrm (P 〈 0.05). Conclusions: VRMs can improve oxygenation and alveolar recruitment during CPPV at relatively low PEEP, but are relatively less effective than a continuous high PEEP level.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/s001340051196
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