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Is smaller high enough? Another piece in the puzzle of stress, strain, size, and systems
Extracorporeal lung-supporting procedures open the possibility of staying within widely accepted margins of 'protective' mechanical ventilation (tidal volume of less than 6 mL per kg of predicted ideal body weight and plateau pressure of less than 30 cm H(2)O) in most any case of respirato...
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Formato: | Texto |
Lenguaje: | English |
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BioMed Central
2009
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689463/ https://www.ncbi.nlm.nih.gov/pubmed/19435467 http://dx.doi.org/10.1186/cc7738 |
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author | Quintel, Michael Moerer, Onnen |
author_facet | Quintel, Michael Moerer, Onnen |
author_sort | Quintel, Michael |
collection | PubMed |
description | Extracorporeal lung-supporting procedures open the possibility of staying within widely accepted margins of 'protective' mechanical ventilation (tidal volume of less than 6 mL per kg of predicted ideal body weight and plateau pressure of less than 30 cm H(2)O) in most any case of respiratory failure or even of further reducing ventilator settings while still providing adequate gas exchange. There is evidence that, at least in some patients, a further reduction in tidal volumes might be beneficial. Extracorporeal procedures to support the lungs have undergone tremendous technical developments, thus reducing the procedure-related risks. However, what is true for ventilator settings should also be true for extracorporeal procedures: studies will have to demonstrate a convincing risk-benefit ratio. In addition, a simple reduction of the tidal volume will certainly not be the right answer. If extracorporeal support largely influences gas exchange, the 'optimal' tidal volume/positive end-expiratory pressure ratio keeping stress and strain low and avoiding alveolar derecruitment will still have to be individually defined. |
format | Text |
id | pubmed-2689463 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2009 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-26894632010-03-30 Is smaller high enough? Another piece in the puzzle of stress, strain, size, and systems Quintel, Michael Moerer, Onnen Crit Care Commentary Extracorporeal lung-supporting procedures open the possibility of staying within widely accepted margins of 'protective' mechanical ventilation (tidal volume of less than 6 mL per kg of predicted ideal body weight and plateau pressure of less than 30 cm H(2)O) in most any case of respiratory failure or even of further reducing ventilator settings while still providing adequate gas exchange. There is evidence that, at least in some patients, a further reduction in tidal volumes might be beneficial. Extracorporeal procedures to support the lungs have undergone tremendous technical developments, thus reducing the procedure-related risks. However, what is true for ventilator settings should also be true for extracorporeal procedures: studies will have to demonstrate a convincing risk-benefit ratio. In addition, a simple reduction of the tidal volume will certainly not be the right answer. If extracorporeal support largely influences gas exchange, the 'optimal' tidal volume/positive end-expiratory pressure ratio keeping stress and strain low and avoiding alveolar derecruitment will still have to be individually defined. BioMed Central 2009 2009-03-30 /pmc/articles/PMC2689463/ /pubmed/19435467 http://dx.doi.org/10.1186/cc7738 Text en Copyright © 2009 BioMed Central Ltd |
spellingShingle | Commentary Quintel, Michael Moerer, Onnen Is smaller high enough? Another piece in the puzzle of stress, strain, size, and systems |
title | Is smaller high enough? Another piece in the puzzle of stress, strain, size, and systems |
title_full | Is smaller high enough? Another piece in the puzzle of stress, strain, size, and systems |
title_fullStr | Is smaller high enough? Another piece in the puzzle of stress, strain, size, and systems |
title_full_unstemmed | Is smaller high enough? Another piece in the puzzle of stress, strain, size, and systems |
title_short | Is smaller high enough? Another piece in the puzzle of stress, strain, size, and systems |
title_sort | is smaller high enough? another piece in the puzzle of stress, strain, size, and systems |
topic | Commentary |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689463/ https://www.ncbi.nlm.nih.gov/pubmed/19435467 http://dx.doi.org/10.1186/cc7738 |
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