scholarly journals Positive end-expiratory pressure selection based on best respiratory system compliance or collapse/hyperdistension curves in patients with acute respiratory distress syndrome: lack of correlation with alveolar recruitment

2017 ◽  
Vol 44 (3) ◽  
pp. 389-391 ◽  
Author(s):  
Po-Lan Su ◽  
Wei-Chieh Lin ◽  
Yen-Fen Ko ◽  
Pei-Fang Su ◽  
Chang-Wen Chen
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Respiratory System ◽  
Distress Syndrome ◽  
Alveolar Recruitment ◽  
Respiratory System Compliance ◽  
Positive End Expiratory Pressure ◽  
Pressure Selection

Individualized positive end-expiratory pressure setting in patients with severe acute respiratory distress syndrome supported with veno-venous extracorporeal membrane oxygenation

Perfusion ◽  
2020 ◽  
pp. 026765912094672
Author(s):  
Chengfen Yin ◽  
Xinjing Gao ◽  
Chao Cao ◽  
Lei Xu ◽  
Xing Lu
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Respiratory System Compliance ◽  
Positive End Expiratory Pressure ◽  
Pressure Setting ◽  
Membrane Oxygenation

Background: Patients with acute respiratory distress syndrome supported with veno-venous extracorporeal membrane oxygenation benefit from higher positive end-expiratory pressure combined with conventional ventilation during the early extracorporeal membrane oxygenation period. The role of incremental positive end-expiratory pressure titration in patients with severe acute respiratory distress syndrome supported with veno-venous extracorporeal membrane oxygenation remains unclear. This study aimed to determine the preferred method for setting positive end-expiratory pressure in patients with severe acute respiratory distress syndrome on veno-venous extracorporeal membrane oxygenation support. Methods: We retrospectively reviewed all subjects supported with veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome from 2009 to 2019 in the intensive care units in Tianjin Third Central Hospital. Subjects were divided into two groups according to the positive end-expiratory pressure titration method used: P-V curve (quasi-static pressure-volume curve-guided positive end-expiratory pressure setting) group or Crs (respiratory system compliance-guided positive end-expiratory pressure setting) group. Results: Forty-three subjects were included in the clinical outcome analysis: 20 in the P-V curve group and 23 in the Crs group. Initial positive end-expiratory pressure levels during veno-venous extracorporeal membrane oxygenation were similar in both groups. Incidence rates of barotrauma and hemodynamic events were significantly lower in the Crs group (all p < 0.05). Mechanical ventilation duration, intensive care unit length of stay, and hospital length of stay were significantly shorter in the Crs group than the P-V curve group (all p < 0.05). Subjects in the Crs group showed non-significant improvements in the duration of extracorporeal membrane oxygenation support and 28-day mortality (p > 0.05). Conclusion: Respiratory system compliance-guided positive end-expiratory pressure setting may lead to more optimal clinical outcomes for patients with severe acute respiratory distress syndrome supported by veno-venous extracorporeal membrane oxygenation. Moreover, the operation is simple, safe, and convenient in clinical practice.

Cardiorespiratory Effects of Positive End-expiratory Pressure during Progressive Tidal Volume Reduction (Permissive Hypercapnia) in Patients with Acute Respiratory Distress Syndrome

1995 ◽  
Vol 83 (4) ◽  
pp. 710-720. ◽  
Author(s):  
V. Marco Ranieri ◽  
Luciana Mascia ◽  
Tommaso Fiore ◽  
Francesco Bruno ◽  
Antonio Brienza ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Gas Exchange ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Tidal Volume ◽  
Distress Syndrome ◽  
Alveolar Recruitment ◽  
Permissive Hypercapnia ◽  
Positive End Expiratory Pressure

Background In patients with acute respiratory distress syndrome (ARDS), the ventilatory approach is based on tidal volume (VT) of 10-15 ml/kg and positive end-expiratory pressure (PEEP). To avoid further pulmonary injury, decreasing VT and allowing PaCO2 to increase (permissive hypercapnia) has been suggested. Effects of 10 cmH2O of PEEP on respiratory mechanics, hemodynamics, and gas exchange were compared during mechanical ventilation with conventional (10-15 ml/kg) and low (5-8 ml/kg) VT. Methods Nine sedated and paralyzed patients were studied. VT was decreased gradually (50 ml every 20-30 min). Static volume-pressure (V-P) curves, hemodynamics, and gas exchange were measured. Results During mechanical ventilation with conventional VT, V-P curves on PEEP 0 (ZEEP) exhibited an upward convexity in six patients reflecting a progressive reduction in compliance with inflating volume, whereas PEEP resulted in a volume displacement along the flat part of this curve. After VT reduction, V-P curves in the same patients showed an upward concavity, reflecting progressive alveolar recruitment with inflating volume, and application of PEEP resulted in alveolar recruitment. The other three patients showed a V-P curve with an upward concavity; VT reduction increased this concavity, and application of PEEP induced greater alveolar recruitment than during conventional VT. With PEEP, cardiac index decreased by, respectively, 31% during conventional VT and 11% during low VT (P &lt; 0.01); PaO2 increased by 32% and 71% (P &lt; 0.01), respectively, whereas right-to-left venous admixture (Qs/Qt) decreased by 11% and 40%, respectively (P &lt; 0.01). The greatest values of PaO2, static compliance, and oxygen delivery and the lowest values of Qs/Qt (best PEEP) were obtained during application of PEEP with low VT (P &lt; 0.01). Conclusions Although PEEP induced alveolar hyperinflation in most patients during mechanical ventilation with conventional VT, at low VT, there appeared to be a significant alveolar collapse, and PEEP was able to expand these units, improving gas exchange and hemodynamics.

scholarly journals Respiratory effects of lung recruitment maneuvers depend on the recruitment-to-inflation ratio in patients with COVID-19-related acute respiratory distress syndrome

Critical Care ◽  
2022 ◽  
Vol 26 (1) ◽  
Author(s):  
Yoann Zerbib ◽  
Alexis Lambour ◽  
Julien Maizel ◽  
Loay Kontar ◽  
Bertrand De Cagny ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Respiratory System ◽  
Pulse Pressure ◽  
Distress Syndrome ◽  
Lung Recruitment ◽  
Respiratory System Compliance ◽  
Recruitment Maneuvers

Abstract Background In the context of acute respiratory distress syndrome (ARDS), the response to lung recruitment maneuvers (LRMs) varies considerably from one patient to another and so is difficult to predict. The aim of the study was to determine whether or not the recruitment-to-inflation (R/I) ratio could differentiate between patients according to the change in lung mechanics during the LRM. Methods We evaluated the changes in gas exchange and respiratory mechanics induced by a stepwise LRM at a constant driving pressure of 15 cmH2O during pressure-controlled ventilation. We assessed lung recruitability by measuring the R/I ratio. Patients were dichotomized with regard to the median R/I ratio. Results We included 30 patients with moderate-to-severe ARDS and a median [interquartile range] R/I ratio of 0.62 [0.42–0.83]. After the LRM, patients with high recruitability (R/I ratio ≥ 0.62) presented an improvement in the PaO2/FiO2 ratio, due to significant increase in respiratory system compliance (33 [27–42] vs. 42 [35–60] mL/cmH2O; p < 0.001). In low recruitability patients (R/I < 0.62), the increase in PaO2/FiO2 ratio was associated with a significant decrease in pulse pressure as a surrogate of cardiac output (70 [55–85] vs. 50 [51–67] mmHg; p = 0.01) but not with a significant change in respiratory system compliance (33 [24–47] vs. 35 [25–47] mL/cmH2O; p = 0.74). Conclusion After the LRM, patients with high recruitability presented a significant increase in respiratory system compliance (indicating a gain in ventilated area), while those with low recruitability presented a decrease in pulse pressure suggesting a drop in cardiac output and therefore in intrapulmonary shunt.

scholarly journals Driving pressure y mortalidad en el síndrome de distrés respiratorio agudo

2019 ◽  
Vol 11 (8) ◽  
pp. 2
Author(s):  
Isabel de la Calle Gil ◽  
Rosalía Navarro Casado ◽  
Raquel García Álvarez
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Protective Ventilation ◽  
Alveolar Recruitment ◽  
Driving Pressure ◽  
Lung Protective Ventilation ◽  
Positive End Expiratory Pressure ◽  
Current Guidelines

Las actuales guías de manejo del síndrome de distrés respiratorio agudo (SDRA) recomiendan una ventilación protectora: volumen corriente bajo, presión positiva al final de la espiración (PEEP) adecuada y maniobras de reclutamiento alveolar. Sin embargo, estudios recientes han mostrado que la driving pressure podría ser la variable que mejor se correlaciona con la supervivencia en pacientes con SDRA. ABSTRACT Driving pressure and mortality in acute respiratory distress syndrome Current guidelines for ventilation in patients with acute respiratory distress syndrome (ARDS) recommend lung-protective ventilation: use of low tidal volumes, appropiate  positive end-expiratory pressure and alveolar recruitment maneuvers. However, recent studies have shown that driving pressure could be the variable that best correlated with survival in patients with ARDS.

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