Protective ventilation in experimental acute respiratory distress syndrome after ventilator-induced lung injury: a randomized controlled trial
(2012) In British Journal of Anaesthesia 109(4). p.584-594- Abstract
- Low tidal volume (V-T), PEEP, and low plateau pressure (P-PLAT) are lung protective during acute respiratory distress syndrome (ARDS). This study tested the hypothesis that the aspiration of dead space (ASPIDS) together with computer simulation can help maintain gas exchange at these settings, thus promoting protection of the lungs. ARDS was induced in pigs using surfactant perturbation plus an injurious ventilation strategy. One group then underwent 24 h protective ventilation, while control groups were ventilated using a conventional ventilation strategy at either high or low pressure. Pressurevolume curves (P-el/V), blood gases, and haemodynamics were studied at 0, 4, 8, 16, and 24 h after the induction of ARDS and lung histology was... (More)
- Low tidal volume (V-T), PEEP, and low plateau pressure (P-PLAT) are lung protective during acute respiratory distress syndrome (ARDS). This study tested the hypothesis that the aspiration of dead space (ASPIDS) together with computer simulation can help maintain gas exchange at these settings, thus promoting protection of the lungs. ARDS was induced in pigs using surfactant perturbation plus an injurious ventilation strategy. One group then underwent 24 h protective ventilation, while control groups were ventilated using a conventional ventilation strategy at either high or low pressure. Pressurevolume curves (P-el/V), blood gases, and haemodynamics were studied at 0, 4, 8, 16, and 24 h after the induction of ARDS and lung histology was evaluated. The P-el/V curves showed improvements in the protective strategy group and deterioration in both control groups. In the protective group, when respiratory rate (RR) was approximate to 60 bpm, better oxygenation and reduced shunt were found. Histological damage was significantly more severe in the high-pressure group. There were no differences in venous oxygen saturation and pulmonary vascular resistance between the groups. The protective ventilation strategy of adequate pH or Pa-CO2 with minimal V-T, and high/safe P-PLAT resulting in high PEEP was based on the avoidance of known lung-damaging phenomena. The approach is based upon the optimization of V-T, RR, PEEP, I/E, and dead space. This study does not lend itself to conclusions about the independent role of each of these features. However, dead space reduction is fundamental for achieving minimal V-T at high RR. Classical physiology is applicable at high RR. Computer simulation optimizes ventilation and limiting of dead space using ASPIDS. Inspiratory P-el/V curves recorded from PEEP or, even better, expiratory P-el/V curves allow monitoring in ARDS. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/3189793
- author
- Uttman, Leif LU ; Bitzén, Ulrika LU ; De Robertis, E. ; Enoksson, Jens LU ; Johansson, Leif LU and Jonson, Björn LU
- organization
- publishing date
- 2012
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- ARDS, computer simulation, dead space, pressurevolume curve, protective, ventilation
- in
- British Journal of Anaesthesia
- volume
- 109
- issue
- 4
- pages
- 584 - 594
- publisher
- Elsevier
- external identifiers
-
- wos:000308886700016
- scopus:84866356532
- pmid:22846562
- ISSN
- 1471-6771
- DOI
- 10.1093/bja/aes230
- language
- English
- LU publication?
- yes
- additional info
- The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Pathology, (Lund) (013030000), Department of Clinical Physiology (Lund) (013013000), Department of Political Science (012015000)
- id
- 170958e1-5a8b-4d97-92f4-5ae2cd2775a1 (old id 3189793)
- date added to LUP
- 2016-04-01 10:27:39
- date last changed
- 2022-04-27 22:19:39
@article{170958e1-5a8b-4d97-92f4-5ae2cd2775a1,
abstract = {{Low tidal volume (V-T), PEEP, and low plateau pressure (P-PLAT) are lung protective during acute respiratory distress syndrome (ARDS). This study tested the hypothesis that the aspiration of dead space (ASPIDS) together with computer simulation can help maintain gas exchange at these settings, thus promoting protection of the lungs. ARDS was induced in pigs using surfactant perturbation plus an injurious ventilation strategy. One group then underwent 24 h protective ventilation, while control groups were ventilated using a conventional ventilation strategy at either high or low pressure. Pressurevolume curves (P-el/V), blood gases, and haemodynamics were studied at 0, 4, 8, 16, and 24 h after the induction of ARDS and lung histology was evaluated. The P-el/V curves showed improvements in the protective strategy group and deterioration in both control groups. In the protective group, when respiratory rate (RR) was approximate to 60 bpm, better oxygenation and reduced shunt were found. Histological damage was significantly more severe in the high-pressure group. There were no differences in venous oxygen saturation and pulmonary vascular resistance between the groups. The protective ventilation strategy of adequate pH or Pa-CO2 with minimal V-T, and high/safe P-PLAT resulting in high PEEP was based on the avoidance of known lung-damaging phenomena. The approach is based upon the optimization of V-T, RR, PEEP, I/E, and dead space. This study does not lend itself to conclusions about the independent role of each of these features. However, dead space reduction is fundamental for achieving minimal V-T at high RR. Classical physiology is applicable at high RR. Computer simulation optimizes ventilation and limiting of dead space using ASPIDS. Inspiratory P-el/V curves recorded from PEEP or, even better, expiratory P-el/V curves allow monitoring in ARDS.}},
author = {{Uttman, Leif and Bitzén, Ulrika and De Robertis, E. and Enoksson, Jens and Johansson, Leif and Jonson, Björn}},
issn = {{1471-6771}},
keywords = {{ARDS; computer simulation; dead space; pressurevolume curve; protective; ventilation}},
language = {{eng}},
number = {{4}},
pages = {{584--594}},
publisher = {{Elsevier}},
series = {{British Journal of Anaesthesia}},
title = {{Protective ventilation in experimental acute respiratory distress syndrome after ventilator-induced lung injury: a randomized controlled trial}},
url = {{http://dx.doi.org/10.1093/bja/aes230}},
doi = {{10.1093/bja/aes230}},
volume = {{109}},
year = {{2012}},
}