Data di Pubblicazione:
2010
Citazione:
Lung opening and closing during ventilation of acute
respiratory distress syndrome / P. Caironi, M. Cressoni, D. Chiumello, M. Ranieri, M. Quintel, S.G. Russo,
R. Cornejo, G. Bugedo, E. Carlesso, R. Russo, L. Caspani, L. Gattinoni. - In: AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE. - ISSN 1073-449X. - 181:6(2010 Mar 15), pp. 578-586.
Abstract:
Rationale: The effects of high positive end-expiratory pressure (PEEP)
strictly depend on lung recruitability, which varies widely during
acute respiratory distress syndrome (ARDS). Unfortunately, increasing
PEEP may lead to opposing effects on two main factors potentially
worsening the lung injury, that is, alveolar strain and intratidal
opening and closing, being detrimental (increasing the former) or
beneficial (decreasing the latter).
Objectives: To investigate how lung recruitability influences alveolar
strainandintratidalopeningandclosing after the application of high
PEEP.
Methods:We analyzed data from a database of 68 patients with acute
lung injury or ARDS who underwent whole-lung computed tomography
at 5, 15, and 45 cm H2O airway pressure.
Measurements and Main Results: End-inspiratory nonaerated lung
tissue was estimated from computed tomography pressure–volume
curves. Alveolar strain and opening and closing lung tissue were
computed at 5 and 15 cm H2O PEEP. In patients with a higher percentage
of potentially recruitable lung, the increase in PEEPmarkedly
reduced opening and closing lung tissue (P , 0.001), whereas no
differences were observed in patients with a lower percentage of
potentially recruitable lung. In contrast, alveolar strain similarly
increased in the two groups (P 5 0.89). Opening and closing lung
tissuewasdistributedmainly in the dependent andhilar lung regions,
andit appearedtobe an independent risk factor fordeath (odds ratio,
1.10 for each 10-g increase).
Conclusions: In ARDS, especially in patients with higher lung recruitability,
the beneficial impact of reducing intratidal alveolar opening
and closing by increasing PEEP prevails over the effects of increasing
alveolar strain.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Acute lung injury; Acute respiratory distress syndrome; Mechanical ventilation; Ventilator-induced lung injury
Elenco autori:
P. Caironi, M. Cressoni, D. Chiumello, M. Ranieri, M. Quintel, S.G. Russo,
R. Cornejo, G. Bugedo, E. Carlesso, R. Russo, L. Caspani, L. Gattinoni
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