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Individualized Posi...
Individualized Positive End-expiratory Pressure and Regional Gas Exchange in Porcine Lung Injury
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- Muders, Thomas (författare)
- Univ Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53105 Bonn, Germany.
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- Luepschen, Henning (författare)
- Univ Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53105 Bonn, Germany.
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- Meier, Torsten (författare)
- Univ Schleswig Holstein, Dept Anesthesiol & Intens Care Med, Campus Lubeck, Lubeck, Germany.
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- Reske, Andreas Wolfgang (författare)
- Univ Leipzig, Dept Anesthesiol & Intens Care Med, Leipzig, Germany.
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- Zinserling, Joerg (författare)
- Univ Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53105 Bonn, Germany.;Bundesinst Arzneimittel & Medizinprodukte BfArM, Fed Inst Drugs & Med Devices, Bonn, Germany.
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- Kreyer, Stefan (författare)
- Univ Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53105 Bonn, Germany.
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- Pikkemaat, Robert (författare)
- Rhein Westfal TH Aachen, Philips Chair Med Informat Technol, Helmholtz Inst Biomed Engn, Aachen, Germany.
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- Maripu, Enn (författare)
- Univ Hosp, Dept Med Phys, Uppsala, Sweden.
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- Leonhardt, Steffen (författare)
- Rhein Westfal TH Aachen, Philips Chair Med Informat Technol, Helmholtz Inst Biomed Engn, Aachen, Germany.
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- Hedenstierna, Göran, 1941- (författare)
- Uppsala universitet,Klinisk fysiologi
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- Putensen, Christian (författare)
- Univ Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53105 Bonn, Germany.
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- Wrigge, Hermann (författare)
- Bergmannstrost Hosp Halle, Dept Anesthesiol Intens Care & Emergency Med, Pain Therapy, Halle, Germany.
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Univ Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53105 Bonn, Germany Univ Schleswig Holstein, Dept Anesthesiol & Intens Care Med, Campus Lubeck, Lubeck, Germany. (creator_code:org_t)
- LIPPINCOTT WILLIAMS & WILKINS, 2020
- 2020
- Engelska.
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Ingår i: Anesthesiology. - : LIPPINCOTT WILLIAMS & WILKINS. - 0003-3022 .- 1528-1175. ; 132:4, s. 808-824
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Background: In acute respiratory failure elevated intraabdominal pressure aggravates lung collapse, tidal recruitment, and ventilation inhomogeneity. Low positive end-expiratory pressure (PEEP) may promote lung collapse and intrapulmonary shunting, whereas high PEEP may increase dead space by inspiratory overdistension. The authors hypothesized that an electrical impedance tomography-guided PEEP approach minimizing tidal recruitment improves regional ventilation and perfusion matching when compared to a table-based low PEEP/no recruitment and an oxygenation-guided high PEEP/full recruitment strategy in a hybrid model of lung injury and elevated intraabdominal pressure. Methods: In 15 pigs with oleic acid-induced lung injury intraabdominal pressure was increased by intraabdominal saline infusion. PEEP was set in randomized order: (1) guided by a PEEP/inspired oxygen fraction table, without recruitment maneuver; (2) minimizing tidal recruitment guided by electrical impedance tomography after a recruitment maneuver; and (3) maximizing oxygenation after a recruitment maneuver. Single photon emission computed tomography was used to analyze regional ventilation, perfusion, and aeration. Primary outcome measures were differences in PEEP levels and regional ventilation/perfusion matching. Results: Resulting PEEP levels were different (mean +/- SD) with (1) table PEEP: 11 +/- 3 cm H2O; (2) minimal tidal recruitment PEEP: 22 +/- 3 cm H2O; and (3) maximal oxygenation PEEP: 25 +/- 4 cm H2O; P < 0.001. Table PEEP without recruitment maneuver caused highest lung collapse (28 +/- 11% vs. 5 +/- 5% vs. 4 +/- 4%; P < 0.001), shunt perfusion (3.2 +/- 0.8 l/min vs. 1.0 +/- 0.8 l/min vs. 0.7 +/- 0.6 l/min; P < 0.001) and dead space ventilation (2.9 +/- 1.0 l/min vs. 1.5 +/- 0.7 l/min vs. 1.7 +/- 0.8 l/min; P < 0.001). Although resulting in different PEEP levels, minimal tidal recruitment and maximal oxygenation PEEP, both following a recruitment maneuver, had similar effects on regional ventilation/perfusion matching. Conclusions: When compared to table PEEP without a recruitment maneuver, both minimal tidal recruitment PEEP and maximal oxygenation PEEP following a recruitment maneuver decreased shunting and dead space ventilation, and the effects of minimal tidal recruitment PEEP and maximal oxygenation PEEP were comparable.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
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Muders, Thomas
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Luepschen, Henni ...
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Meier, Torsten
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Reske, Andreas W ...
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Zinserling, Joer ...
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Kreyer, Stefan
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Pikkemaat, Rober ...
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Maripu, Enn
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Leonhardt, Steff ...
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Hedenstierna, Gö ...
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Putensen, Christ ...
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Wrigge, Hermann
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