One-Lung Ventilation with High Tidal Volumes and Zero Positive End-Expiratory Pressure Is Injurious in the Isolated Rabbit Lung Model

Abreu, Marcelo Gama de; Heintz, Manuel; Heller, A. R.; Széchényi, Roswitha; Albrecht, D. M.; Koch, Thea

doi:10.1213/00000539-200301000-00045

Cited by 87 publications

(46 citation statements)

References 32 publications

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“…Some studies have indicated that potential lung injury may be induced by one-lung hyperventilation, pulmonary stretch, and pleural damage (de Abreu et al, 2003;Gothard, 2006;Unzueta et al, 2007). However, according to our research, a more rapid recovery can be observed in the ALMT group compared with the MS group.…”

Section: Discussionsupporting

confidence: 44%

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

Ding

Jiang

Tao

et al. 2014

J. Zhejiang Univ. Sci. B

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Abstract:Objective: Mitral valve disease tends to be treated with anterolateral minithoracotomy (ALMT) rather than median sternotomy (MS), as ALMT uses progressively smaller incisions to promote better cosmetic outcomes. This meta-analysis quantifies the effects of ALMT on surgical parameters and post-operative outcomes compared with MS. Methods: One randomized controlled study and four case-control studies, published in English from January 1996 to January 2013, were identified and evaluated. Results: ALMT showed a significantly longer cardiopulmonary bypass time (P=0.001) and aortic cross-clamp time (P=0.05) compared with MS. However, the benefits of ALMT were evident as demonstrated by a shorter length of hospital stay (P<0.00001). According to operative complications, the onset of new arrhythmias following ALMT decreased significantly as compared with MS (P=0.05); however, the incidence of peri-operative mortality (P=0.62), re-operation for bleeding (P=0.37), neurologic events (P=0.77), myocardial infarction (P=0.84), gastrointestinal complications (P=0.89), and renal insufficiency (P=0.67) were similar to these of MS. Long-term follow-up data were also examined, and revealed equivalent survival and freedom from mitral valve events. Conclusions: Current clinical data suggest that ALMT is a safe and effective alternative to the conventional approach and is associated with better short-term outcomes and a trend towards longer survival.

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Section: Discussionsupporting

confidence: 44%

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

Ding

Jiang

Tao

et al. 2014

J. Zhejiang Univ. Sci. B

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“…In 20 paralysed children with acute respiratory distress syndrome, NEVE et al [54] showed that the analysis of the profile of the dynamic pressure/time curve during constant flow ventilation permits detection of hyperinflation and has a good agreement with the results of the static pressure/volume curve. GAMA DE ABREU et al [55] in a rabbit model of unilateral acute respiratory distress syndrome confirmed that the analysis of the pressure/time curve during constant flow ventilation allows detection of optimal protective strategy also during one-lung ventilation. These data therefore suggest that the shape of the dynamic inspiratory pressure/time profile during constant flow inflation (stress index) allows prediction of a ventilatory strategy that minimises the occurrence of ventilator-induced lung injury.…”

Section: Constant Flow Techniquementioning

confidence: 77%

How respiratory system mechanics may help in minimising ventilator-induced lung injury in ARDS patients

Terragni¹,

Rosboch²,

Lisi³

et al. 2003

Eur Respir J

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The main supportive therapy in acute respiratory distress syndrome patients is mechanical ventilation. As with any therapy, mechanical ventilation has sideeffects, and may induce lung injury (ventilator-induced lung injury (VILI)/ventilatorassociated lung injury). The mechanical factors responsible for VILI are thought to be related to tidal recruitment/derecruitment of previously collapsed alveoli and/or pulmonary overdistension.The volume/pressure (V/P) curve of the respiratory system in patients as well as in animal models of acute lung injury (ALI) has a characteristic sigmoid shape, with a lower inflection point (LIP) corresponding to the pressure/end-expiratory volume required to initiate recruitment of collapsed alveoli, and an upper inflection point (UIP) corresponding to the pressure/end inspiratory volume at which alveolar overdistension occurs. "Protective" ventilatory approaches have therefore set out to minimise mechanical injury by using the V/P curve to individualise positive end-expiratory pressure (PEEP) (PEEP above the LIP) and tidal volume (by setting end-inspiratory V/P below the UIP) since a large number of experimental studies correlate P/V curves to histological and biological manifestations of VILI and two randomised trials showed that protective ventilatory strategy individually tailored to the P/V curve minimised pulmonary and systemic inflammation and decreased mortality in patients with ALI.However, despite the fact that several studies have: 1) proposed new techniques to perform pressure/volume curves at the bedside, 2) confirmed that the lower inflection point and upper inflection point correspond to computed tomography scan evidence of atelectasis and overdistension, and 3) demonstrated the ability of the pressure/volume curve to estimate alveolar recruitment with positive end-expiratory pressure, no large studies have assessed whether such measurement can be performed in all intensive care units as a monitoring tool to orient ventilator therapy. Preliminary experimental and clinical studies show that the shape of the dynamic inspiratory pressure/time profile during constant flow inflation (stress index), allows prediction of a ventilatory strategy that minimises the occurrence of ventilator-induced lung injury. Eur Respir J 2003; 22: Suppl. 42, 15s-21s.

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“…Üstelik son yıllarda yüksek TV ile ventile olan akciğerdeki enflamasyon ilişkisi gerek deneysel, gerekse klinik çalışmalarda gösterilmekte-dir (12)(13)(14)(15) . Çift akciğerdekine benzer TV'lerin uygulandığı geleneksel TAV stratejisi ile akciğer mekaniğin-de bozulma, ağırlık artışı ve pulmoner hipertansiyon gelişimi saptanmıştır (13,16) . Akciğerlerdeki aşırı gerilmenin düşük TV ve ılımlı bir PEEP kullanımı ile önü-ne geçilebileceği kaydedilmiştir.…”

Section: Discussionunclassified

Effects of Lower Tidal Volumes on Oxygenation During One-Lung Ventilation

Ulke¹,

Kose²,

Çamcı³

et al. 2011

GKDA Derg

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One-Lung Ventilation with High Tidal Volumes and Zero Positive End-Expiratory Pressure Is Injurious in the Isolated Rabbit Lung Model

Cited by 87 publications

References 32 publications

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

How respiratory system mechanics may help in minimising ventilator-induced lung injury in ARDS patients

Effects of Lower Tidal Volumes on Oxygenation During One-Lung Ventilation

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