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Respective effects of end-expiratory and end-inspiratory pressures on alveolar recruitment in acute lung injury

Richard, JC; Brochard, L; Vandelet, P; Breton, L; Maggiore, SM; Jonson, Björn LU ; Clabault, K; Leroy, J and Bonmarchand, G (2003) In Critical Care Medicine 31(1). p.89-92
Abstract
Objective. A low tidal volume can induce alveolar derecruitment in patients with acute lung injury. This study was undertaken to evaluate whether this resulted mainly from the decrease in tidal volume per se or from the reduction in end-inspiratory plateau pressure and whether there is any benefit in raising the level of positive end-expiratory pressure (PEEP) while plateau pressure is kept constant. Design: Prospective crossover study. Setting: Medical intensive care unit of a university teaching hospital. Patients: Fifteen adult patients ventilated for acute lung injury (PaO2/FIO2, 158 +/- 34 mm Hg; lung injury score, 2.7 +/- 0.6). Interventions: Three combinations were tested: PEEP at the lower inflection point with 6 mL/kg tidal... (More)
Objective. A low tidal volume can induce alveolar derecruitment in patients with acute lung injury. This study was undertaken to evaluate whether this resulted mainly from the decrease in tidal volume per se or from the reduction in end-inspiratory plateau pressure and whether there is any benefit in raising the level of positive end-expiratory pressure (PEEP) while plateau pressure is kept constant. Design: Prospective crossover study. Setting: Medical intensive care unit of a university teaching hospital. Patients: Fifteen adult patients ventilated for acute lung injury (PaO2/FIO2, 158 +/- 34 mm Hg; lung injury score, 2.7 +/- 0.6). Interventions: Three combinations were tested: PEEP at the lower inflection point with 6 mL/kg tidal volume, PEEP at the lower inflection point with 10 mL/kg tidal volume, and high PEEP with tidal volume at 6 mL/kg, keeping the plateau pressure similar to the preceding condition. Measurements and Main Results: Pressure-volume curves at zero PEEP and at set PEEP were recorded, and recruitment was calculated as the volume difference between both curves for pressures ranging from 15 to 30 cm H2O. Arterial blood gases were measured for all patients. For a similar PEEP at the lower inflection point (10 +/- 3 cm H2O), tidal volume reduction (10 to 6 mL/kg) led to a significant derecruitment. A low tidal volume (6 mL/kg) with high PEEP (14 +/- 3 cm H2O), however, induced a significantly greater recruitment and a higher PaO2 than the two other strategies. Conclusion. At a given plateau pressure (i.e., similar end-inspiratory distension), lowering tidal volume and increasing PEEP increase recruitment and PaO2. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
positive end-expiratory pressure, plateau pressure, acute respiratory distress syndrome, lung protective strategy, alveolar recruitment, pressure-volume curve
in
Critical Care Medicine
volume
31
issue
1
pages
89 - 92
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000180714800014
  • pmid:12544999
ISSN
1530-0293
DOI
10.1097/01.CCM.0000037960.70104.1E
language
English
LU publication?
yes
id
9ffffdc0-8ca6-4e30-bebe-17b338141c10 (old id 318722)
date added to LUP
2007-09-20 15:38:13
date last changed
2016-04-16 05:26:03
@article{9ffffdc0-8ca6-4e30-bebe-17b338141c10,
  abstract     = {Objective. A low tidal volume can induce alveolar derecruitment in patients with acute lung injury. This study was undertaken to evaluate whether this resulted mainly from the decrease in tidal volume per se or from the reduction in end-inspiratory plateau pressure and whether there is any benefit in raising the level of positive end-expiratory pressure (PEEP) while plateau pressure is kept constant. Design: Prospective crossover study. Setting: Medical intensive care unit of a university teaching hospital. Patients: Fifteen adult patients ventilated for acute lung injury (PaO2/FIO2, 158 +/- 34 mm Hg; lung injury score, 2.7 +/- 0.6). Interventions: Three combinations were tested: PEEP at the lower inflection point with 6 mL/kg tidal volume, PEEP at the lower inflection point with 10 mL/kg tidal volume, and high PEEP with tidal volume at 6 mL/kg, keeping the plateau pressure similar to the preceding condition. Measurements and Main Results: Pressure-volume curves at zero PEEP and at set PEEP were recorded, and recruitment was calculated as the volume difference between both curves for pressures ranging from 15 to 30 cm H2O. Arterial blood gases were measured for all patients. For a similar PEEP at the lower inflection point (10 +/- 3 cm H2O), tidal volume reduction (10 to 6 mL/kg) led to a significant derecruitment. A low tidal volume (6 mL/kg) with high PEEP (14 +/- 3 cm H2O), however, induced a significantly greater recruitment and a higher PaO2 than the two other strategies. Conclusion. At a given plateau pressure (i.e., similar end-inspiratory distension), lowering tidal volume and increasing PEEP increase recruitment and PaO2.},
  author       = {Richard, JC and Brochard, L and Vandelet, P and Breton, L and Maggiore, SM and Jonson, Björn and Clabault, K and Leroy, J and Bonmarchand, G},
  issn         = {1530-0293},
  keyword      = {positive end-expiratory pressure,plateau pressure,acute respiratory distress syndrome,lung protective strategy,alveolar recruitment,pressure-volume curve},
  language     = {eng},
  number       = {1},
  pages        = {89--92},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Critical Care Medicine},
  title        = {Respective effects of end-expiratory and end-inspiratory pressures on alveolar recruitment in acute lung injury},
  url          = {http://dx.doi.org/10.1097/01.CCM.0000037960.70104.1E},
  volume       = {31},
  year         = {2003},
}