Dynamic hyperinflation and intrinsic positive end-expiratory pressure in ARDS patients.
Aged
Analysis of Variance
Blood Gas Analysis
Female
Humans
Intrinsic Factor
Lung
/ physiopathology
Lung Compliance
/ physiology
Male
Middle Aged
Positive-Pressure Respiration
/ classification
Respiratory Distress Syndrome
/ physiopathology
Respiratory Mechanics
Retrospective Studies
Tidal Volume
/ physiology
Acute respiratory distress syndrome
Gas exchange
Intrinsic positive end-expiratory pressure
Respiratory mechanics
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
27 Nov 2019
27 Nov 2019
Historique:
received:
01
05
2019
accepted:
13
09
2019
entrez:
29
11
2019
pubmed:
30
11
2019
medline:
6
5
2020
Statut:
epublish
Résumé
In ARDS patients, changes in respiratory mechanical properties and ventilatory settings can cause incomplete lung deflation at end-expiration. Both can promote dynamic hyperinflation and intrinsic positive end-expiratory pressure (PEEP). The aim of this study was to investigate, in a large population of ARDS patients, the presence of intrinsic PEEP, possible associated factors (patients' characteristics and ventilator settings), and the effects of two different external PEEP levels on the intrinsic PEEP. We made a secondary analysis of published data. Patients were ventilated with a tidal volume of 6-8 mL/kg of predicted body weight, sedated, and paralyzed. After a recruitment maneuver, a PEEP trial was run at 5 and 15 cmH We enrolled 217 sedated, paralyzed patients: 87 (40%) had intrinsic PEEP with a median of 1.1 [1.0-2.3] cmH In sedated, paralyzed ARDS patients without a known obstructive disease, the amount of intrinsic PEEP during lung-protective ventilation is negligible and does not influence respiratory mechanical properties.
Sections du résumé
BACKGROUND
BACKGROUND
In ARDS patients, changes in respiratory mechanical properties and ventilatory settings can cause incomplete lung deflation at end-expiration. Both can promote dynamic hyperinflation and intrinsic positive end-expiratory pressure (PEEP). The aim of this study was to investigate, in a large population of ARDS patients, the presence of intrinsic PEEP, possible associated factors (patients' characteristics and ventilator settings), and the effects of two different external PEEP levels on the intrinsic PEEP.
METHODS
METHODS
We made a secondary analysis of published data. Patients were ventilated with a tidal volume of 6-8 mL/kg of predicted body weight, sedated, and paralyzed. After a recruitment maneuver, a PEEP trial was run at 5 and 15 cmH
RESULTS
RESULTS
We enrolled 217 sedated, paralyzed patients: 87 (40%) had intrinsic PEEP with a median of 1.1 [1.0-2.3] cmH
CONCLUSIONS
CONCLUSIONS
In sedated, paralyzed ARDS patients without a known obstructive disease, the amount of intrinsic PEEP during lung-protective ventilation is negligible and does not influence respiratory mechanical properties.
Identifiants
pubmed: 31775830
doi: 10.1186/s13054-019-2611-6
pii: 10.1186/s13054-019-2611-6
pmc: PMC6880369
doi:
Substances chimiques
Intrinsic Factor
9008-12-2
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
375Commentaires et corrections
Type : CommentIn
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