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  • Muders, ThomasUniv Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53105 Bonn, Germany. (author)

Individualized Positive End-expiratory Pressure and Regional Gas Exchange in Porcine Lung Injury

  • Article/chapterEnglish2020

Publisher, publication year, extent ...

  • LIPPINCOTT WILLIAMS & WILKINS,2020
  • printrdacarrier

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  • LIBRIS-ID:oai:DiVA.org:uu-412297
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-412297URI
  • https://doi.org/10.1097/ALN.0000000000003151DOI

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  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • 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.

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  • Luepschen, HenningUniv Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53105 Bonn, Germany. (author)
  • Meier, TorstenUniv Schleswig Holstein, Dept Anesthesiol & Intens Care Med, Campus Lubeck, Lubeck, Germany. (author)
  • Reske, Andreas WolfgangUniv Leipzig, Dept Anesthesiol & Intens Care Med, Leipzig, Germany. (author)
  • Zinserling, JoergUniv Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53105 Bonn, Germany.;Bundesinst Arzneimittel & Medizinprodukte BfArM, Fed Inst Drugs & Med Devices, Bonn, Germany. (author)
  • Kreyer, StefanUniv Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53105 Bonn, Germany. (author)
  • Pikkemaat, RobertRhein Westfal TH Aachen, Philips Chair Med Informat Technol, Helmholtz Inst Biomed Engn, Aachen, Germany. (author)
  • Maripu, EnnUniv Hosp, Dept Med Phys, Uppsala, Sweden. (author)
  • Leonhardt, SteffenRhein Westfal TH Aachen, Philips Chair Med Informat Technol, Helmholtz Inst Biomed Engn, Aachen, Germany. (author)
  • Hedenstierna, Göran,1941-Uppsala universitet,Klinisk fysiologi(Swepub:uu)goranhed (author)
  • Putensen, ChristianUniv Hosp Bonn, Dept Anesthesiol & Intens Care Med, D-53105 Bonn, Germany. (author)
  • Wrigge, HermannBergmannstrost Hosp Halle, Dept Anesthesiol Intens Care & Emergency Med, Pain Therapy, Halle, Germany. (author)
  • 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)

Related titles

  • In:Anesthesiology: LIPPINCOTT WILLIAMS & WILKINS132:4, s. 808-8240003-30221528-1175

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