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Adjusting tidal vol...
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Ferrando, Carlos
(författare)
Adjusting tidal volume to stress index in an open lung condition optimizes ventilation and prevents overdistension in an experimental model of lung injury and reduced chest wall compliance
- Artikel/kapitelEngelska2015
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2015-12-01
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Springer Science and Business Media LLC,2015
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electronicrdacarrier
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LIBRIS-ID:oai:DiVA.org:uu-251854
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-251854URI
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https://doi.org/10.1186/s13054-014-0726-3DOI
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Språk:engelska
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Sammanfattning på:engelska
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Ämneskategori:art swepub-publicationtype
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Introduction: The stress index ( SI), a parameter derived from the shape of the pressure-time curve, can identify injurious mechanical ventilation. We tested the hypothesis that adjusting tidal volume (VT) to a non-injurious SI in an open lung condition avoids hypoventilation while preventing overdistension in an experimental model of combined lung injury and low chest-wall compliance (Ccw). Methods: Lung injury was induced by repeated lung lavages using warm saline solution, and Ccw was reduced by controlled intra-abdominal air-insufflation in 22 anesthetized, paralyzed and mechanically ventilated pigs. After injury animals were recruited and submitted to a positive end-expiratory pressure (PEEP) titration trial to find the PEEP level resulting in maximum compliance. During a subsequent four hours of mechanical ventilation, VT was adjusted to keep a plateau pressure (Pplat) of 30 cmH2O (Pplat-group, n = 11) or to a SI between 0.95 and 1.05 (SI-group, n = 11). Respiratory rate was adjusted to maintain a 'normal' PaCO2 (35 to 65 mmHg). SI, lung mechanics, arterial-blood gases haemodynamics pro-inflammatory cytokines and histopathology were analyzed. In addition Computed Tomography (CT) data were acquired at end expiration and end inspiration in six animals. Results: PaCO2 was significantly higher in the Pplat-group (82 versus 53 mmHg, P = 0.01), with a resulting lower pH (7.19 versus 7.34, P = 0.01). We observed significant differences in VT (7.3 versus 5.4 mlKg-1, P = 0.002) and Pplat values (30 versus 35 cmH2O, P = 0.001) between the Pplat-group and SI-group respectively. SI (1.03 versus 0.99, P = 0.42) and end-inspiratory transpulmonary pressure (PTP) (17 versus 18 cmH2O, P = 0.42) were similar in the Pplat-and SI-groups respectively, without differences in overinflated lung areas at end-inspiration in both groups. Cytokines and histopathology showed no differences. Conclusions: Setting tidal volume to a non-injurious stress index in an open lung condition improves alveolar ventilation and prevents overdistension without increasing lung injury. This is in comparison with limited Pplat protective ventilation in a model of lung injury with low chest-wall compliance.
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Suarez-Sipmann, FernandoUppsala universitet,Hedenstiernalaboratoriet(Swepub:uu)fersi946
(författare)
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Gutierrez, Andrea
(författare)
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Tusman, Gerardo
(författare)
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Carbonell, Jose
(författare)
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Garcia, Marisa
(författare)
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Piqueras, Laura
(författare)
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Compan, Desamparados
(författare)
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Flores, Susanie
(författare)
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Soro, Marina
(författare)
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Llombart, Alicia
(författare)
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Javier Belda, Francisco
(författare)
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Uppsala universitetHedenstiernalaboratoriet
(creator_code:org_t)
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Ingår i:Critical Care: Springer Science and Business Media LLC191364-85351466-609X
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Ferrando, Carlos
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Suarez-Sipmann, ...
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Gutierrez, Andre ...
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Tusman, Gerardo
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Carbonell, Jose
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Garcia, Marisa
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visa fler...
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Piqueras, Laura
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Compan, Desampar ...
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Flores, Susanie
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Soro, Marina
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Llombart, Alicia
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Javier Belda, Fr ...
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visa färre...
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