Bedside selection of positive end-expiratory pressure in mild, moderate, and severe acute respiratory distress syndrome
Articolo
Data di Pubblicazione:
2014
Citazione:
Bedside selection of positive end-expiratory pressure in mild, moderate, and severe acute respiratory distress syndrome / D. Chiumello, M. Cressoni, E. Carlesso, M.L. Caspani, A. Marino, E. Gallazzi, P. Caironi, M. Lazzerini, O. Moerer, M. Quintel, L. Gattinoni. - In: CRITICAL CARE MEDICINE. - ISSN 0090-3493. - 42:2(2014 Feb), pp. 252-264. [10.1097/CCM.0b013e3182a6384f]
Abstract:
OBJECTIVE::
Positive end-expiratory pressure exerts its effects keeping open at end-expiration previously collapsed areas of the lung; consequently, higher positive end-expiratory pressure should be limited to patients with high recruitability. We aimed to determine which bedside method would provide positive end-expiratory pressure better related to lung recruitability.
DESIGN::
Prospective study performed between 2008 and 2011.
SETTING::
Two university hospitals (Italy and Germany).
PATIENTS::
Fifty-one patients with acute respiratory distress syndrome.
INTERVENTIONS::
Whole lung CT scans were taken in static conditions at 5 and 45 cm H2O during an end-expiratory/end-inspiratory pause to measure lung recruitability. To select individual positive end-expiratory pressure, we applied bedside methods based on lung mechanics (ExPress, stress index), esophageal pressure, and oxygenation (higher positive end-expiratory pressure table of lung open ventilation study).
MEASUREMENTS AND MAIN RESULTS::
Patients were classified in mild, moderate and severe acute respiratory distress syndrome. Positive end-expiratory pressure levels selected by the ExPress, stress index, and absolute esophageal pressures methods were unrelated with lung recruitability, whereas positive end-expiratory pressure levels selected by the lung open ventilation method showed a weak relationship with lung recruitability (r = 0.29; p < 0.0001). When patients were classified according to the acute respiratory distress syndrome Berlin definition, the lung open ventilation method was the only one which gave lower positive end-expiratory pressure levels in mild and moderate acute respiratory distress syndrome compared with severe acute respiratory distress syndrome (8 ± 2 and 11 ± 3 cm H2O vs 15 ± 3 cm H2O; p < 0.05), whereas ExPress, stress index, and esophageal pressure methods gave similar positive end-expiratory pressure values in mild, moderate, and severe acute respiratory distress syndrome. The positive end-expiratory pressure selected by the different methods were unrelated to each other with the exception of the two methods based on lung mechanics (ExPress and stress index).
CONCLUSIONS::
Bedside positive end-expiratory pressure selection methods based on lung mechanics or absolute esophageal pressures provide positive end-expiratory pressure levels unrelated to lung recruitability and similar in mild, moderate, and severe acute respiratory distress syndrome, whereas the oxygenation-based method provided positive end-expiratory pressure levels related with lung recruitability progressively increasing from mild to moderate and severe acute respiratory distress syndrome.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Acute Respiratory Distress Syndrome; Lung; Lung Collapse; Positive End-Expiratory Pressure; Positive-Pressure Respiration; Respiratory Mechanics
Elenco autori:
D. Chiumello, M. Cressoni, E. Carlesso, M.L. Caspani, A. Marino, E. Gallazzi, P. Caironi, M. Lazzerini, O. Moerer, M. Quintel, L. Gattinoni
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