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Dynamic hyperinflation and intrinsic positive end-expiratory pressure in ARDS patients
BACKGROUND: In ARDS patients, changes in respiratory mechanical properties and ventilatory settings can cause incomplete lung deflation at end-expiration. Both can promote dynamic hyperinflation and intrinsic positive end-expiratory pressure (PEEP). The aim of this study was to investigate, in a lar...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880369/ https://www.ncbi.nlm.nih.gov/pubmed/31775830 http://dx.doi.org/10.1186/s13054-019-2611-6 |
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author | Coppola, Silvia Caccioppola, Alessio Froio, Sara Ferrari, Erica Gotti, Miriam Formenti, Paolo Chiumello, Davide |
author_facet | Coppola, Silvia Caccioppola, Alessio Froio, Sara Ferrari, Erica Gotti, Miriam Formenti, Paolo Chiumello, Davide |
author_sort | Coppola, Silvia |
collection | PubMed |
description | BACKGROUND: In ARDS patients, changes in respiratory mechanical properties and ventilatory settings can cause incomplete lung deflation at end-expiration. Both can promote dynamic hyperinflation and intrinsic positive end-expiratory pressure (PEEP). The aim of this study was to investigate, in a large population of ARDS patients, the presence of intrinsic PEEP, possible associated factors (patients’ characteristics and ventilator settings), and the effects of two different external PEEP levels on the intrinsic PEEP. METHODS: We made a secondary analysis of published data. Patients were ventilated with a tidal volume of 6–8 mL/kg of predicted body weight, sedated, and paralyzed. After a recruitment maneuver, a PEEP trial was run at 5 and 15 cmH(2)O, and partitioned mechanics measurements were collected after 20 min of stabilization. Lung computed tomography scans were taken at 5 and 45 cmH(2)O. Patients were classified into two groups according to whether or not they had intrinsic PEEP at the end of an expiratory pause. RESULTS: We enrolled 217 sedated, paralyzed patients: 87 (40%) had intrinsic PEEP with a median of 1.1 [1.0–2.3] cmH(2)O at 5 cmH(2)O of PEEP. The intrinsic PEEP significantly decreased with higher PEEP (1.1 [1.0–2.3] vs 0.6 [0.0–1.0] cmH(2)O; p < 0.001). The applied tidal volume was significantly lower (480 [430–540] vs 520 [445–600] mL at 5 cmH(2)O of PEEP; 480 [430–540] vs 510 [430–590] mL at 15 cmH(2)O) in patients with intrinsic PEEP, while the respiratory rate was significantly higher (18 [15–20] vs 15 [13–19] bpm at 5 cmH(2)O of PEEP; 18 [15–20] vs 15 [13–19] bpm at 15 cmH(2)O). At both PEEP levels, the total airway resistance and compliance of the respiratory system were not different in patients with and without intrinsic PEEP. The total lung gas volume and lung recruitability were also not different between patients with and without intrinsic PEEP (respectively 961 [701–1535] vs 973 [659–1433] mL and 15 [0–32] % vs 22 [0–36] %). CONCLUSIONS: In sedated, paralyzed ARDS patients without a known obstructive disease, the amount of intrinsic PEEP during lung-protective ventilation is negligible and does not influence respiratory mechanical properties. |
format | Online Article Text |
id | pubmed-6880369 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-68803692019-11-29 Dynamic hyperinflation and intrinsic positive end-expiratory pressure in ARDS patients Coppola, Silvia Caccioppola, Alessio Froio, Sara Ferrari, Erica Gotti, Miriam Formenti, Paolo Chiumello, Davide Crit Care Research BACKGROUND: In ARDS patients, changes in respiratory mechanical properties and ventilatory settings can cause incomplete lung deflation at end-expiration. Both can promote dynamic hyperinflation and intrinsic positive end-expiratory pressure (PEEP). The aim of this study was to investigate, in a large population of ARDS patients, the presence of intrinsic PEEP, possible associated factors (patients’ characteristics and ventilator settings), and the effects of two different external PEEP levels on the intrinsic PEEP. METHODS: We made a secondary analysis of published data. Patients were ventilated with a tidal volume of 6–8 mL/kg of predicted body weight, sedated, and paralyzed. After a recruitment maneuver, a PEEP trial was run at 5 and 15 cmH(2)O, and partitioned mechanics measurements were collected after 20 min of stabilization. Lung computed tomography scans were taken at 5 and 45 cmH(2)O. Patients were classified into two groups according to whether or not they had intrinsic PEEP at the end of an expiratory pause. RESULTS: We enrolled 217 sedated, paralyzed patients: 87 (40%) had intrinsic PEEP with a median of 1.1 [1.0–2.3] cmH(2)O at 5 cmH(2)O of PEEP. The intrinsic PEEP significantly decreased with higher PEEP (1.1 [1.0–2.3] vs 0.6 [0.0–1.0] cmH(2)O; p < 0.001). The applied tidal volume was significantly lower (480 [430–540] vs 520 [445–600] mL at 5 cmH(2)O of PEEP; 480 [430–540] vs 510 [430–590] mL at 15 cmH(2)O) in patients with intrinsic PEEP, while the respiratory rate was significantly higher (18 [15–20] vs 15 [13–19] bpm at 5 cmH(2)O of PEEP; 18 [15–20] vs 15 [13–19] bpm at 15 cmH(2)O). At both PEEP levels, the total airway resistance and compliance of the respiratory system were not different in patients with and without intrinsic PEEP. The total lung gas volume and lung recruitability were also not different between patients with and without intrinsic PEEP (respectively 961 [701–1535] vs 973 [659–1433] mL and 15 [0–32] % vs 22 [0–36] %). CONCLUSIONS: In sedated, paralyzed ARDS patients without a known obstructive disease, the amount of intrinsic PEEP during lung-protective ventilation is negligible and does not influence respiratory mechanical properties. BioMed Central 2019-11-27 /pmc/articles/PMC6880369/ /pubmed/31775830 http://dx.doi.org/10.1186/s13054-019-2611-6 Text en © The Author(s). 2019 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 Coppola, Silvia Caccioppola, Alessio Froio, Sara Ferrari, Erica Gotti, Miriam Formenti, Paolo Chiumello, Davide Dynamic hyperinflation and intrinsic positive end-expiratory pressure in ARDS patients |
title | Dynamic hyperinflation and intrinsic positive end-expiratory pressure in ARDS patients |
title_full | Dynamic hyperinflation and intrinsic positive end-expiratory pressure in ARDS patients |
title_fullStr | Dynamic hyperinflation and intrinsic positive end-expiratory pressure in ARDS patients |
title_full_unstemmed | Dynamic hyperinflation and intrinsic positive end-expiratory pressure in ARDS patients |
title_short | Dynamic hyperinflation and intrinsic positive end-expiratory pressure in ARDS patients |
title_sort | dynamic hyperinflation and intrinsic positive end-expiratory pressure in ards patients |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880369/ https://www.ncbi.nlm.nih.gov/pubmed/31775830 http://dx.doi.org/10.1186/s13054-019-2611-6 |
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