Effect of positive end-expiratory pressure on extravascular lung water in porcine acute respiratory failure

Myers, John C.; Reilley, Thomas E.; Cloutier, Charles T.

doi:10.1097/00003246-198801000-00010

Cited by 30 publications

(17 citation statements)

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“…The majority of studies focused on the effect of changes in PEEP (23,29,37,47,55,78,93,106,115,116,136) with a smaller number investigating the effect of VT and PEEP on lung fluid balance (23,29). The data demonstrate that if sufficient preemptive PEEP is applied, lung water will be significantly diminished in multiple lung injury models including high vascular pressure (23,47,106,116), high alveolar surface tension (78), high endothelial permeability (29,55,93,115), and high airway pressure (37,136). Also, PEEP is most effective at reducing edema when applied soon after injury (47,114).…”

Section: Physiological Evidence That the Mechanical Breath Can Block mentioning

confidence: 99%

“…Many studies have also shown that altering the MB P can reduce edema formation in high vascular permeability-induced edema (29,55,93,115). In a pig oleic acid model, Colmenero-Ruiz (29) showed that application of PEEP (10 cmH 2 O) immediately following oleic acid infusion reduced pulmonary edema, and that a concomitant reduction in VT further reduced the accumulation of lung water.…”

Section: Synthesis Reviewmentioning

confidence: 99%

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Impact of mechanical ventilation on the pathophysiology of progressive acute lung injury

Nieman

Gatto

Habashi

2015

Journal of Applied Physiology

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Nieman GF, Gatto LA, Habashi NM. Impact of mechanical ventilation on the pathophysiology of progressive acute lung injury. J Appl Physiol 119: 1245-1261. First published October 15, 2015 doi:10.1152/japplphysiol.00659.2015The earliest description of what is now known as the acute respiratory distress syndrome (ARDS) was a highly lethal double pneumonia. Ashbaugh and colleagues (Ashbaugh DG, Bigelow DB, Petty TL, Levine BE Lancet 2: 319-323, 1967) correctly identified the disease as ARDS in 1967. Their initial study showing the positive effect of mechanical ventilation with positive end-expiratory pressure (PEEP) on ARDS mortality was dampened when it was discovered that improperly used mechanical ventilation can cause a secondary ventilator-induced lung injury (VILI), thereby greatly exacerbating ARDS mortality. This Synthesis Report will review the pathophysiology of ARDS and VILI from a mechanical stress-strain perspective. Although inflammation is also an important component of VILI pathology, it is secondary to the mechanical damage caused by excessive strain. The mechanical breath will be deconstructed to show that multiple parameters that comprise the breath-airway pressure, flows, volumes, and the duration during which they are applied to each breath-are critical to lung injury and protection. Specifically, the mechanisms by which a properly set mechanical breath can reduce the development of excessive fluid flux and pulmonary edema, which are a hallmark of ARDS pathology, are reviewed. Using our knowledge of how multiple parameters in the mechanical breath affect lung physiology, the optimal combination of pressures, volumes, flows, and durations that should offer maximum lung protection are postulated. acute lung injury; lung; pathophysiology ventilator; VILI THE POLIO EPIDEMIC OF 1916 inspired many treatment attempts including vitamin C therapy, hydrotherapy, and electrotherapy, but no effective therapy was found until Philip Drinker's group invented negative pressure mechanical ventilation-the iron lung. Their landmark paper, "The use of a new apparatus for the prolonged administration of artificial respiration: I. A fatal case of poliomyelitis," published in 1929, demonstrated the effective clinical use of this device (Fig. 1) (38). The concept of conversion from negative to positive pressure ventilation was based on technical advances that were made during World War II to deliver pressurized oxygen to high-altitude fighter and bomber pilots. Concomitant with these technologic advances in mechanical ventilation was the realization that what was originally thought to be a universally fatal form of double pneumonia was indeed a unique clinical entity that we now call the acute respiratory distress syndrome (ARDS). In a 1967 seminal paper published in The Lancet, Ashbaugh et al. (10) first identified and described ARDS as a collection of pathologic abnormalities that can be caused by many unrelated insults such as sepsis, hemorrhagic shock, pneumonia, and trauma to name a few. The disease and the ventil...

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Section: Physiological Evidence That the Mechanical Breath Can Block mentioning

confidence: 99%

Section: Synthesis Reviewmentioning

confidence: 99%

Impact of mechanical ventilation on the pathophysiology of progressive acute lung injury

Nieman

Gatto

Habashi

2015

Journal of Applied Physiology

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“…They exposed the animals to varying rates of fluid resuscitation and applied increasing levels of PEEP and compared them with a control group with no PEEP. EVLW in the pigs who received PEEP was less than or equal to the EVLW in the control group independent of how much fluid resuscitation the animals had received (30). Thus PEEP may provide a protective effect, limiting the amount of lung water in the setting of ALI and fluid resuscitation.…”

Section: Limitations Of Evlw Measurementmentioning

confidence: 90%

Measurement of extravascular lung water using the single indicator method in patients: research and potential clinical value

Brown

Liu²,

Matthay

2009

American Journal of Physiology-Lung Cellular and Molecular Phys

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Extravascular lung water includes all of the fluid within the lung but outside of the vasculature. Lung water increases as a result of increased hydrostatic vascular pressure or from an increase in lung endothelial and epithelial permeability or both. Experimentally, extravascular lung water has been measured gravimetrically. Clinically, the chest radiograph is used to determine whether extravascular lung water is present but is an insensitive instrument for determining the quantity of lung water. Bedside measurement of extravascular lung water in patients is now possible using a single indicator thermodilution method. This review critically evaluates the experimental and clinical evidence supporting the potential value of measuring extravascular lung water in patients using the single indicator method.

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“…This may explain the observation by some experimental studies a decrease in EVLW measured by dilution techniques during PEEP application. 91 In contrast, PEEP may induce a redistribution of pulmonary blood flow toward previously excluded areas and hence artificially ''increase'' EVLW by recruiting the lungs. 87,92 It is important to appreciate that in addition to potentially affecting measurement of EVLW by dilution method, PEEP may also have an effect on the real amount of EVLW; in case of elevated pulmonary capillary pressure due to LV dysfunction, the application of PEEP may decrease EVLW by decreasing pulmonary capillary pressure.…”

Section: Vascular Obstructionmentioning

confidence: 99%

The PiCCO Monitor

Oren-Grinberg¹

2010

International Anesthesiology Clinics

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Effect of positive end-expiratory pressure on extravascular lung water in porcine acute respiratory failure

Cited by 30 publications

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Impact of mechanical ventilation on the pathophysiology of progressive acute lung injury

Impact of mechanical ventilation on the pathophysiology of progressive acute lung injury

Measurement of extravascular lung water using the single indicator method in patients: research and potential clinical value

The PiCCO Monitor

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