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High Positive End-E...
High Positive End-Expiratory Pressure Renders Spontaneous Effort Noninjurious
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- Morais, Caio C. A. (author)
- Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil
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- Koyama, Yukiko (author)
- Osaka Univ Hosp, Intens Care Unit, Suita, Osaka, Japan
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- Yoshida, Takeshi (author)
- Osaka Univ Hosp, Intens Care Unit, Suita, Osaka, Japan;Univ Toronto, Hosp Sick Children, Dept Crit Care Med & Anesthesia, Translat Med, 686 Bay St, Toronto, ON M5G 0A4, Canada
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- Plens, Glauco M. (author)
- Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil
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- Gomes, Susimeire (author)
- Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil
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- Lima, Cristhiano A. S. (author)
- Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil
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- Ramos, Ozires P. S. (author)
- Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil
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- Pereira, Sergio M. (author)
- Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil
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- Kawaguchi, Naomasa (author)
- Osaka Univ, Sch Allied Hlth Sci, Dept Pathol, Grad Sch Med, Suita, Osaka, Japan
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- Yamamoto, Hirofumi (author)
- Osaka Univ, Sch Allied Hlth Sci, Dept Pathol, Grad Sch Med, Suita, Osaka, Japan
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- Uchiyama, Akinori (author)
- Osaka Univ Hosp, Intens Care Unit, Suita, Osaka, Japan
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- Batista Borges, João, 1966- (author)
- Uppsala universitet,Anestesiologi och intensivvård,Hedenstiernalaboratoriet
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- Melo, Marcos F. Vidal (author)
- Harvard Univ, Massachusetts Gen Hosp, Dept Anesthesia Crit Care & Pain Med, Boston, MA USA
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- Tucci, Mauro R. (author)
- Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil
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- Amato, Marcelo B. P. (author)
- Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil
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- Kavanagh, Brian P. (author)
- Univ Toronto, Hosp Sick Children, Dept Crit Care Med & Anesthesia, Translat Med, 686 Bay St, Toronto, ON M5G 0A4, Canada
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- Costa, Eduardo L. V. (author)
- Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil
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- Fujino, Yuji (author)
- Osaka Univ Hosp, Intens Care Unit, Suita, Osaka, Japan
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(creator_code:org_t)
- AMER THORACIC SOC, 2018
- 2018
- English.
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In: American Journal of Respiratory and Critical Care Medicine. - : AMER THORACIC SOC. - 1073-449X .- 1535-4970. ; 197:10, s. 1285-1296
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Rationale: In acute respiratory distress syndrome (ARDS), atelectatic solid-like lung tissue impairs transmission of negative swings in pleural pressure (Ppl) that result from diaphragmatic contraction. The localization of more negative Ppl proportionally increases dependent lung stretch by drawing gas either from other lung regions (e.g., nondependent lung [pendelluft]) or from the ventilator. Lowering the level of spontaneous effort and/or converting solid-like to fluid-like lung might render spontaneous effort noninjurious.Objectives: To determine whether spontaneous effort increases dependent lung injury, and whether such injury would be reduced by recruiting atelectatic solid-like lung with positive end-expiratory pressure (PEEP).Methods: Established models of severe ARDS (rabbit, pig) were used. Regional histology (rabbit), inflammation (positron emission tomography; pig), regional inspiratory Ppl (intrabronchial balloon manometry), and stretch (electrical impedance tomography; pig) were measured. Respiratory drive was evaluated in 11 patients with ARDS.Measurements and Main Results: Although injury during muscle paralysis was predominantly in nondependent and middle lung regions at low (vs. high) PEEP, strong inspiratory effort increased injury (indicated by positron emission tomography and histology) in dependent lung. Stronger effort (vs. muscle paralysis) caused local overstretch and greater tidal recruitment in dependent lung, where more negative Ppl was localized and greater stretch was generated. In contrast, high PEEP minimized lung injury by more uniformly distributing negative Ppl, and lowering the magnitude of spontaneous effort (i.e., deflection in esophageal pressure observed in rabbits, pigs, and patients).Conclusions: Strong effort increased dependent lung injury, where higher local lung stress and stretch was generated; effort-dependent lung injury was minimized by high PEEP in severe ARDS, which may offset need for paralysis.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Lungmedicin och allergi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Respiratory Medicine and Allergy (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
Keyword
- acute respiratory distress syndrome
- spontaneous breathing
- ventilator-induced lung injury
- PEEP
Publication and Content Type
- ref (subject category)
- art (subject category)
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Morais, Caio C. ...
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Koyama, Yukiko
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Yoshida, Takeshi
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Plens, Glauco M.
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Gomes, Susimeire
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Lima, Cristhiano ...
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Ramos, Ozires P. ...
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Pereira, Sergio ...
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Kawaguchi, Naoma ...
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Yamamoto, Hirofu ...
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Uchiyama, Akinor ...
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Batista Borges, ...
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Melo, Marcos F. ...
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Tucci, Mauro R.
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Amato, Marcelo B ...
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Kavanagh, Brian ...
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Costa, Eduardo L ...
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Fujino, Yuji
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Anesthesiology a ...
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Uppsala University