ISSN:
1432-1238
Keywords:
Key words Acute lung injury
;
Kinetic therapy
;
Ventilation-perfusion relationships
;
Intrapulmonary shunt
;
Multiple inert gas elimination technique
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Objective: To investigate ventilation-perfusion (VA/Q) relationships, during continuous axial rotation and in the supine position, in patients with acute lung injury (ALI) using the multiple inert gas elimination technique. Design: Prospective investigation. Setting: Eighteen-bed intensive care unit in a university hospital. Patients and interventions: Ten patients with ALI (PaO2/FIO2 ratio 〈 300 mm Hg) were mechanically ventilated in a pressure controlled mode and placed on a kinetic treatment table. Measurements and results: Distributions of VA/Q were determined 1) during rotation (after a period of 20 min) and 2) after a resting period of 20 min in the supine position. During axial rotation, intrapulmonary shunt (19.1 ± 15 % of cardiac output) was significantly reduced in comparison with when in the supine position (23 ± 14 %, p 〈 0.05), areas with “low” VA/Q were not affected by the positioning maneuver. General VA/Q mismatch (logarithmic distribution of pulmonary blood flow) was decreased during rotation (0.87 ± 0.37) in comparison with when the patient was in the supine position (0.93 ± 0.37, p 〈 0.05). Arterial oxygenation was significantly improved during continuous rotation (PaO2/FIO2 = 217 ± 137 mm Hg) as compared with in the supine position (PaO2/FIO2 = 174 ± 82 mm Hg, p 〈 0.05). The positive response of the continuous rotation on arterial oxygenation was only demonstrated in patients with a Murray Score of 2.5 or less, indicating a “mild to moderate” lung injury, while in patients presenting with progressive ARDS (Murray Score 〉 2.5), the acute positive response was limited. Conclusions: Continuous axial rotation might be a method for an acute reduction of VA/Q mismatch in patients with mild to moderate ALI, but this technique is not effective in late or progressive ARDS. Further studies including a large data collection are needed.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/s001340050534
