scholarly journals Open lung approach with low tidal volume mechanical ventilation attenuates lung injury in rats with massive brain damage

Critical Care ◽  
2014 ◽  
Vol 18 (2) ◽  
pp. R59 ◽  
Author(s):  
Joerg Krebs ◽  
Charalambos Tsagogiorgas ◽  
Paolo Pelosi ◽  
Patricia RM Rocco ◽  
Maximilia Hottenrott ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Lung Injury ◽  
Tidal Volume ◽  
Brain Damage ◽  
Open Lung ◽  
Low Tidal Volume ◽  
Open Lung Approach

scholarly journals Perioperative Open-lung Approach, Regional Ventilation, and Lung Injury in Cardiac Surgery

2020 ◽  
Vol 133 (5) ◽  
pp. 1029-1045 ◽  
Author(s):  
David Lagier ◽  
Lionel J. Velly ◽  
Benoit Guinard ◽  
Nicolas Bruder ◽  
Catherine Guidon ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Lung Injury ◽  
Tidal Volume ◽  
Lung Ventilation ◽  
Soluble Form ◽  
Ventilation Strategy ◽  
Open Lung ◽  
Low Tidal Volume ◽  
Impedance Variation ◽  
Angiopoietin 2

Background In the Protective Ventilation in Cardiac Surgery (PROVECS) randomized, controlled trial, an open-lung ventilation strategy did not improve postoperative respiratory outcomes after on-pump cardiac surgery. In this prespecified subanalysis, the authors aimed to assess the regional distribution of ventilation and plasma biomarkers of lung epithelial and endothelial injury produced by that strategy. Methods Perioperative open-lung ventilation consisted of recruitment maneuvers, positive end-expiratory pressure (PEEP) = 8 cm H2O, and low-tidal volume ventilation including during cardiopulmonary bypass. Control ventilation strategy was a low-PEEP (2 cm H2O) low-tidal volume approach. Electrical impedance tomography was used serially throughout the perioperative period (n = 56) to compute the dorsal fraction of ventilation (defined as the ratio of dorsal tidal impedance variation to global tidal impedance variation). Lung injury was assessed serially using biomarkers of epithelial (soluble form of the receptor for advanced glycation end-products, sRAGE) and endothelial (angiopoietin-2) lung injury (n = 30). Results Eighty-six patients (age = 64 ± 12 yr; EuroSCORE II = 1.65 ± 1.57%) undergoing elective on-pump cardiac surgery were studied. Induction of general anesthesia was associated with ventral redistribution of tidal volumes and higher dorsal fraction of ventilation in the open-lung than the control strategy (0.38 ± 0.07 vs. 0.30 ± 0.10; P = 0.004). No effect of the open-lung strategy on the dorsal fraction of ventilation was noted at the end of surgery after median sternotomy closure (open-lung = 0.37 ± 0.09 vs. control = 0.34 ± 0.11; P = 0.743) or in extubated patients at postoperative day 2 (open-lung = 0.63 ± 0.18 vs. control = 0.59 ± 0.11; P > 0.999). Open-lung ventilation was associated with increased intraoperative plasma sRAGE (7,677 ± 3,097 pg/ml vs. 6,125 ± 1,400 pg/ml; P = 0.037) and had no effect on angiopoietin-2 (P > 0.999). Conclusions In cardiac surgery patients, open-lung ventilation provided larger dorsal lung ventilation early during surgery without a maintained benefit as compared with controls at the end of surgery and postoperative day 2 and was associated with higher intraoperative plasma concentration of sRAGE suggesting lung overdistension. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Management of hypercapnia in critically ill mechanically ventilated patients—A narrative review of literature

2020 ◽  
Vol 21 (4) ◽  
pp. 327-333
Author(s):  
Ravindranath Tiruvoipati ◽  
Sachin Gupta ◽  
David Pilcher ◽  
Michael Bailey
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Dead Space ◽  
Hypercapnic Acidosis ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Low Tidal Volume ◽  
Volume Ventilation ◽  
Low Volume ◽  
Ventilated Patients

The use of lower tidal volume ventilation was shown to improve survival in mechanically ventilated patients with acute lung injury. In some patients this strategy may cause hypercapnic acidosis. A significant body of recent clinical data suggest that hypercapnic acidosis is associated with adverse clinical outcomes including increased hospital mortality. We aimed to review the available treatment options that may be used to manage acute hypercapnic acidosis that may be seen with low tidal volume ventilation. The databases of MEDLINE and EMBASE were searched. Studies including animals or tissues were excluded. We also searched bibliographic references of relevant studies, irrespective of study design with the intention of finding relevant studies to be included in this review. The possible options to treat hypercapnia included optimising the use of low tidal volume mechanical ventilation to enhance carbon dioxide elimination. These include techniques to reduce dead space ventilation, and physiological dead space, use of buffers, airway pressure release ventilation and prone positon ventilation. In patients where hypercapnic acidosis could not be managed with lung protective mechanical ventilation, extracorporeal techniques may be used. Newer, minimally invasive low volume venovenous extracorporeal devices are currently being investigated for managing hypercapnia associated with low and ultra-low volume mechanical ventilation.

Open lung approach ventilation abolishes the negative effects of respiratory rate in experimental lung injury

2016 ◽  
Vol 60 (8) ◽  
pp. 1131-1141 ◽  
Author(s):  
J. Retamal ◽  
J. B. Borges ◽  
A. Bruhn ◽  
R. Feinstein ◽  
G. Hedenstierna ◽  
...  
Keyword(s):  
Lung Injury ◽  
Respiratory Rate ◽  
Negative Effects ◽  
Open Lung ◽  
Open Lung Approach
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