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

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

  • Artikel/kapitelEngelska2020

Förlag, utgivningsår, omfång ...

  • LIPPINCOTT WILLIAMS & WILKINS,2020
  • printrdacarrier

Nummerbeteckningar

  • 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

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

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Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • 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 och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

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

Sammanhörande titlar

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

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