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Protective ventilation in experimental acute respiratory distress syndrome after ventilator-induced lung injury: a randomized controlled trial

Uttman, Leif LU ; Bitzén, Ulrika LU ; De Robertis, E.; Enoksson, Jens LU ; Johansson, Leif LU and Jonson, Björn LU (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:
author
organization
publishing date
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
Macmillan
external identifiers
  • wos:000308886700016
  • scopus:84866356532
ISSN
1471-6771
DOI
10.1093/bja/aes230
language
English
LU publication?
yes
id
170958e1-5a8b-4d97-92f4-5ae2cd2775a1 (old id 3189793)
date added to LUP
2012-12-03 07:09:51
date last changed
2017-03-12 03:10:10
@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},
  keyword      = {ARDS,computer simulation,dead space,pressurevolume curve,protective,ventilation},
  language     = {eng},
  number       = {4},
  pages        = {584--594},
  publisher    = {Macmillan},
  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},
  volume       = {109},
  year         = {2012},
}