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Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients

INTRODUCTION: Lung recruitment maneuvers followed by an individually titrated positive end-expiratory pressure (PEEP) are the key components of the open lung ventilation strategy in acute respiratory distress syndrome (ARDS). The staircase recruitment maneuver is a step-by-step increase in PEEP foll...

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Autores principales: Garnero, Aude, Tuxen, David, Corno, Gaëlle, Durand-Gasselin, Jacques, Hodgson, Carol, Arnal, Jean-Michel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4574463/
https://www.ncbi.nlm.nih.gov/pubmed/26383835
http://dx.doi.org/10.1186/s13054-015-1044-0
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author Garnero, Aude
Tuxen, David
Corno, Gaëlle
Durand-Gasselin, Jacques
Hodgson, Carol
Arnal, Jean-Michel
author_facet Garnero, Aude
Tuxen, David
Corno, Gaëlle
Durand-Gasselin, Jacques
Hodgson, Carol
Arnal, Jean-Michel
author_sort Garnero, Aude
collection PubMed
description INTRODUCTION: Lung recruitment maneuvers followed by an individually titrated positive end-expiratory pressure (PEEP) are the key components of the open lung ventilation strategy in acute respiratory distress syndrome (ARDS). The staircase recruitment maneuver is a step-by-step increase in PEEP followed by a decremental PEEP trial. The duration of each step is usually 2 minutes without physiologic rationale. METHODS: In this prospective study, we measured the dynamic end-expiratory lung volume changes (ΔEELV) during an increase and decrease in PEEP to determine the optimal duration for each step. PEEP was progressively increased from 5 to 40 cmH(2)O and then decreased from 40 to 5 cmH(2)O in steps of 5 cmH(2)O every 2.5 minutes. The dynamic of ΔEELV was measured by direct spirometry as the difference between inspiratory and expiratory tidal volumes over 2.5 minutes following each increase and decrease in PEEP. ΔEELV was separated between the expected increased volume, calculated as the product of the respiratory system compliance by the change in PEEP, and the additional volume. RESULTS: Twenty-six early onset moderate or severe ARDS patients were included. Data are expressed as median [25th-75th quartiles]. During the increase in PEEP, the expected increased volume was achieved within 2[2-2] breaths. During the decrease in PEEP, the expected decreased volume was achieved within 1 [1–1] breath, and 95 % of the additional decreased volume was achieved within 8 [2–15] breaths. Completion of volume changes in 99 % of both increase and decrease in PEEP events required 29 breaths. CONCLUSIONS: In early ARDS, most of the ΔEELV occurs within the first minute, and change is completed within 2 minutes, following an increase or decrease in PEEP.
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spelling pubmed-45744632015-09-19 Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients Garnero, Aude Tuxen, David Corno, Gaëlle Durand-Gasselin, Jacques Hodgson, Carol Arnal, Jean-Michel Crit Care Research INTRODUCTION: Lung recruitment maneuvers followed by an individually titrated positive end-expiratory pressure (PEEP) are the key components of the open lung ventilation strategy in acute respiratory distress syndrome (ARDS). The staircase recruitment maneuver is a step-by-step increase in PEEP followed by a decremental PEEP trial. The duration of each step is usually 2 minutes without physiologic rationale. METHODS: In this prospective study, we measured the dynamic end-expiratory lung volume changes (ΔEELV) during an increase and decrease in PEEP to determine the optimal duration for each step. PEEP was progressively increased from 5 to 40 cmH(2)O and then decreased from 40 to 5 cmH(2)O in steps of 5 cmH(2)O every 2.5 minutes. The dynamic of ΔEELV was measured by direct spirometry as the difference between inspiratory and expiratory tidal volumes over 2.5 minutes following each increase and decrease in PEEP. ΔEELV was separated between the expected increased volume, calculated as the product of the respiratory system compliance by the change in PEEP, and the additional volume. RESULTS: Twenty-six early onset moderate or severe ARDS patients were included. Data are expressed as median [25th-75th quartiles]. During the increase in PEEP, the expected increased volume was achieved within 2[2-2] breaths. During the decrease in PEEP, the expected decreased volume was achieved within 1 [1–1] breath, and 95 % of the additional decreased volume was achieved within 8 [2–15] breaths. Completion of volume changes in 99 % of both increase and decrease in PEEP events required 29 breaths. CONCLUSIONS: In early ARDS, most of the ΔEELV occurs within the first minute, and change is completed within 2 minutes, following an increase or decrease in PEEP. BioMed Central 2015-09-18 2015 /pmc/articles/PMC4574463/ /pubmed/26383835 http://dx.doi.org/10.1186/s13054-015-1044-0 Text en © Garnero et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Garnero, Aude
Tuxen, David
Corno, Gaëlle
Durand-Gasselin, Jacques
Hodgson, Carol
Arnal, Jean-Michel
Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients
title Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients
title_full Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients
title_fullStr Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients
title_full_unstemmed Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients
title_short Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients
title_sort dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4574463/
https://www.ncbi.nlm.nih.gov/pubmed/26383835
http://dx.doi.org/10.1186/s13054-015-1044-0
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