Evaluation of a Ventilation Strategy to Prevent Barotrauma in Patients at High Risk for Acute Respiratory Distress Syndrome

Stewart, Thomas E.; Meade, Maureen O.; Cook, Deborah J.; Granton, John; Hodder, Rick; Lapinsky, Stephen E.; Mazer, C. David; McLean, R F; Rogovein, Ted S.; Schouten, Barbara C.; Todd, Thomas R.J.; Slutsky, Arthur S.

doi:10.1097/00132586-199902000-00009

Cited by 206 publications

(248 citation statements)

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“…2). Results from randomized controlled trials, evaluating the possible benefit of low V T ventilation in patients with ARDS compared with traditional V T ventilation, were divergent, showing a positive or no effect on mortality [1][2][3][4] . From 1996 to 1999, the National Heart, Lung, and Blood Institute ARDS Network enrolled 861 patients at 10 institutions in a randomized controlled trial, known as the Respiratory Management in Acute Lung Injury/ARDS (ARMA) trial 5 .…”

Section: Tidal Volume In Patients With Ali/ardsmentioning

confidence: 99%

Perioperative tidal volume and intra-operative open lung strategy in healthy lungs: where are we going?

Beck‐Schimmer

Schimmer

2010

Best Practice & Research Clinical Anaesthesiology

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Tidal volumes have tremendously decreased over the last decades from <15 ml kg(-1) to approximately 6 ml kg(-1) actual body weight. Guidelines, widely agreed and used, exist for patients with acute lung injury or acute respiratory distress syndrome (ARDS). However, it is questionable if data created in patients with acute lung injury or ARDS from ventilation on intensive care units can be transferred to healthy patients undergoing surgery. Consensus criteria regarding this topic are still missing because only a few randomised controlled trials have been performed to date, focussing on the use of the best intra-operative tidal volume. The same problem has been observed regarding the application of positive end-expiratory pressure (PEEP) and intra-operative lung recruitment. This article provides an overview of the current literature addressing the size of tidal volume, the use of PEEP and the application of the open-lung concept in patients without acute lung injury or ARDS. Pathophysiological aspects of mechanical ventilation are elucidated. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 AbstractTidal volumes have tremendously decreased over the last decades from greater than

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Section: Tidal Volume In Patients With Ali/ardsmentioning

confidence: 99%

Perioperative tidal volume and intra-operative open lung strategy in healthy lungs: where are we going?

Beck‐Schimmer

Schimmer

2010

Best Practice & Research Clinical Anaesthesiology

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“…El empleo de un volumen corriente bajo ha ganado una enorme aceptación 30 después de los resultados de los últimos estudios aleatorizados en una gran población de pacientes con SDRA [31][32][33][34][35][36] . Asimismo, el análi-sis de los parámetros ventilatorios y de las presiones resultantes de su aplicación indica que la presión elevada también es deletérea.…”

Section: Estudios Clínicos Sobre Estrategias De Ventilación Protectorunclassified

Utilidad de las maniobras de reclutamiento (contra)

2009

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“…Lung protection strategy generally requires the use of high PEEP to keep the alveoli open without cyclic distension, or the best PEEP to keep the oxygenation over 92% (8,9). But the use of high PEEP levels may result in severe complications such as www.bjournal.com.br Braz J Med Biol Res 42 (8) 2009 volutrauma, barotrauma and mainly hemodynamic alterations, which can be associated with high tidal inflation or over-distention (1,(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

“…However, there are reports in the literature of lung injury induced by mechanical ventilator (10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Variable positive end-expiratory pressure can maintain oxygenation in experimental acute respiratory distress syndrome induced by oleic acid in dogs

Lanza

Damasceno

Leme

et al. 2009

Braz J Med Biol Res

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The use of positive end-expiratory pressure (PEEP) or lung recruitment maneuvers (RM) to improve oxygenation in acute respiratory distress syndrome (ARDS) is used but it may reduce cardiac output (CO). Intermittent PEEP may avoid these complications. Our objective was to determine if variable PEEP compared with constant PEEP is capable of maintaining arterial oxygenation and minimizing hemodynamic alterations with or without RM. Eighteen dogs with ARDS induced by oleic acid were randomized into three equal groups: group 1, low variable PEEP; group 2, high variable PEEP, and group 3, RM + high variable PEEP. All groups were submitted to constant PEEP, followed by variable PEEP (PEEP was increased from 5 to 10 cmH2O in group 1, and from 5 to 18 cmH2O in the other two groups). PaO2 was higher in group 3 (356.2 ± 65.4 mmHg) than in group 1 (92.7 ± 29.7 mmHg) and group 2 (228.5 ± 72.4 mmHg), P < 0.05. PaO2 was maintained during variable PEEP except in group 2 (318.5 ± 82.9 at constant PEEP to 228.5 ± 72.4 at variable PEEP). There was a reduction in CO in group 3 after RM (3.9 ± 1.1 before to 2.7 ± 0.5 L·min-1·(m2)-1 after; P < 0.05), but there was not any difference between constant and variable PEEP periods (2.7 ± 0.5 and 2.4 ± 0.7 L·min-1·(m2)-1; P > 0.05. Variable PEEP is able to maintain PaO2 when performed in combination with RM in dogs with ARDS. After RM, CO was reduced and there was no relevant difference between the variable and constant PEEP periods

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Evaluation of a Ventilation Strategy to Prevent Barotrauma in Patients at High Risk for Acute Respiratory Distress Syndrome

Cited by 206 publications

References 0 publications

Perioperative tidal volume and intra-operative open lung strategy in healthy lungs: where are we going?

Perioperative tidal volume and intra-operative open lung strategy in healthy lungs: where are we going?

Utilidad de las maniobras de reclutamiento (contra)

Variable positive end-expiratory pressure can maintain oxygenation in experimental acute respiratory distress syndrome induced by oleic acid in dogs

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