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 CPPV LO, CPPV VRM 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 (Q VA/Q T) (0.42 ± 0.07 vs 0.48 ± 0.07, P < 0.01). During CPPV HI, we observed significantly higher PaO2 (139.3 ± 32.5 mmHg) and lower Q VA/Q T (0.37 ± 0.08) compared to CPPV LO (P < 0.01) and to CPPV VRM (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.

Foti, G., Cereda, M., Sparacino, M., De Marchi, L., Villa, F., Pesenti, A. (2000). Effects of periodic lung recruitment maneuvers on gas exchange and respiratory mechanics in mechanically ventilated acute respiratory distress syndrome (ARDS) patients. INTENSIVE CARE MEDICINE, 26(5), 501-507 [10.1007/s001340051196].

Effects of periodic lung recruitment maneuvers on gas exchange and respiratory mechanics in mechanically ventilated acute respiratory distress syndrome (ARDS) patients

FOTI, GIUSEPPE
Primo
;
CEREDA, MAURIZIO
Secondo
;
VILLA, FEDERICO
Penultimo
;
PESENTI, ANTONIO MARIA
Ultimo
2000

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 CPPV LO, CPPV VRM 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 (Q VA/Q T) (0.42 ± 0.07 vs 0.48 ± 0.07, P < 0.01). During CPPV HI, we observed significantly higher PaO2 (139.3 ± 32.5 mmHg) and lower Q VA/Q T (0.37 ± 0.08) compared to CPPV LO (P < 0.01) and to CPPV VRM (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.
Articolo in rivista - Articolo scientifico
Acute respiratory distress syndrome (ARDS); Alveolar recruitment; Barotrauma prevention; Mechanical ventilation; Positive end-expiratory pressure;
English
2000
26
5
501
507
none
Foti, G., Cereda, M., Sparacino, M., De Marchi, L., Villa, F., Pesenti, A. (2000). Effects of periodic lung recruitment maneuvers on gas exchange and respiratory mechanics in mechanically ventilated acute respiratory distress syndrome (ARDS) patients. INTENSIVE CARE MEDICINE, 26(5), 501-507 [10.1007/s001340051196].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/127395
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