Adjusting positive end‐expiratory pressure and tidal volume in acute respiratory distress syndrome according to the pressure–volume curve

Pestaña, David; Hernández-Gancedo, C.; Royo, C.; Uña, R; Villagran, M. J.; Peña, Natalia; Criado, A.

doi:10.1034/j.1399-6576.2003.00011.x

Cited by 14 publications

(7 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the absence of a leak around the ETT, these data support previously published adult studies suggesting that a low-flow technique generates the most accurate estimation of Pflex (19,30,31). In small ETTs, the low-flow approach is particularly important, because the generation of turbulence at higher flows may contribute to inaccuracy.…”

Section: Discussionsupporting

confidence: 87%

See 1 more Smart Citation

Automated measurement of the lower inflection point in a pediatric lung model*

Turner

Heitz²,

Zurakowski³

et al. 2009

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

Estimation of Pflex can be achieved using automated P-V curves with ETTs appropriate for pediatric use, with and without an airleak. ETT size and flow rate affect the accuracy of these measurements when an airleak is present, and use of increased flow rates to create the automated P-V curves can reduce error. These data support the idea that a low-flow technique provides the most accurate determination of Pflex in pediatric patients without a leak around their ETT, whereas increased flows are needed to compensate when an ETT airleak is present.

show abstract

Section: Discussionsupporting

confidence: 87%

“…The low-flow inflation technique is often selected to determine Pflex in an attempt to minimize resistance to flow during the measurements (18,19). Regardless of the technique used, there is controversy in the literature regarding clinicians' ability to create accurate P-V curves at the bedside in patients with acute lung injury and ARDS (17, 19 -22).…”

mentioning

confidence: 99%

Automated measurement of the lower inflection point in a pediatric lung model*

Turner

Heitz²,

Zurakowski³

et al. 2009

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…The stability of the alveolar reexpansion may be limited by the technique used to detect the optimal PEEP. The adjustment of an optimal PEEP using the pressure-volume ( P-V ) curve, as used in this study, is probably one of the most widespread and preferable methods for use at the bedside [22]. However, particularly in patients with “stiff” lungs resulting from severe ARDS, the lower inflection point of the P-V curve may be hard to discern [23].…”

Section: Discussionmentioning

confidence: 99%

Increased Extravascular Lung Water Reduces the Efficacy of Alveolar Recruitment Maneuver in Acute Respiratory Distress Syndrome

Smetkin

Kuzkov

Суборов

et al. 2012

Critical Care Research and Practice

View full text Add to dashboard Cite

Introduction. In acute respiratory distress syndrome (ARDS) the recruitment maneuver (RM) is used to reexpand atelectatic areas of the lungs aiming to improve arterial oxygenation. The goal of our paper was to evaluate the response to RM, as assessed by measurements of extravascular lung water index (EVLWI) in ARDS patients. Materials and Methods. Seventeen adult ARDS patients were enrolled into a prospective study. Patients received protective ventilation. The RM was performed by applying a continuous positive airway pressure of 40 cm H2O for 40 sec. The efficacy of the RM was assessed 5 min later. Patients were identified as responders if PaO2/FiO2 increased by >20% above the baseline. EVLWI was assessed by transpulmonary thermodilution before the RM, and patients were divided into groups of low EVLWI (<10 mL/kg) and high EVLWI (≥10 mL/kg). Results. EVLWI was increased in 12 patients. Following RM, PaO2/FiO2 increased by 33 (4–65) % in the patients with low EVLWI, whereas those in the high EVLWI group experienced a change by only −1((−13)–(+5)) % (P = 0.035). Conclusion. In ARDS, the response to a recruitment maneuver might be related to the severity of pulmonary edema. In patients with incresed EVLWI, the recruitment maneuver is less effective.

show abstract

“…53 However, at pressures above the upper inflection point (UIP), lung structures are overdistended without further recruitment. 52 Thus, to avoid lung damage, the end-inspiratory pressure should not exceed the UIP.…”

Section: Body Positionmentioning

confidence: 99%

“…51 The use of 4-5 cmH 2 O of PEEP may be common, but does not reflect varying clinical conditions in the lungs. The ideal level of PEEP lies above the lower inflection point (LIP) 52 -the pressure that overcomes the opening pressure of the collapsed alveoli. Sometimes, the LIP can be evaluated by examining a pressurevolume curve.…”

Section: Body Positionmentioning

confidence: 99%

Physiology of gas exchange during anaesthesia

Bruells

Rossaint

2011

European Journal of Anaesthesiology

View full text Add to dashboard Cite

Mechanical ventilation is a prerequisite for many surgical interventions. Furthermore, during states of severe gas exchange disturbance or impaired neurological conditions with the threat of aspiration or cardiovascular instability, it is a life-saving intervention on every ICU. Even the induction of anaesthesia disturbs the physiological lung function, due to changes in chest wall mechanics and diaphragm relaxation, generating atelectases, gas exchange disturbance and ventilation-perfusion mismatch. Additionally, the application of positive pressure to lung structures elicits ventilator-induced lung injury, with the severity of injury dependent on the applied volume, peak pressures and levels of positive end-expiratory pressure. Although these pathophysiological changes may be of minor importance for the majority of ventilated patients in the operating room, these mechanisms may harm patients during surgical interventions with the need for one-lung ventilation or with underlying co-morbidities such as chronic obstructive pulmonary disease (COPD) or acute respiratory distress syndrome (ARDS). This review provides an outline of the major components of the pathophysiological changes associated with general anaesthesia and describes the additional risks in patients with COPD and ARDS as common co-morbidities in every hospital.

show abstract

Adjusting positive end‐expiratory pressure and tidal volume in acute respiratory distress syndrome according to the pressure–volume curve

Cited by 14 publications

References 30 publications

Automated measurement of the lower inflection point in a pediatric lung model*

Automated measurement of the lower inflection point in a pediatric lung model*

Increased Extravascular Lung Water Reduces the Efficacy of Alveolar Recruitment Maneuver in Acute Respiratory Distress Syndrome

Physiology of gas exchange during anaesthesia

Contact Info

Product

Resources

About