PEEP-induced changes in lung volume in acute respiratory distress syndrome. Two methods to estimate alveolar recruitment

Dellamonica, Jean; Lerolle, Nicolas; Sargentini, Cyril; Béduneau, G.; Marco, Fabiano Di; Mercat, Alain; Richard, Jean Christophe; Diehl, Jean‐Luc; Mancebo, Jordi; Rouby, Jean‐Jacques; Lü, Qin; Bernardin, G.; Brochard, Laurent

doi:10.1007/s00134-011-2333-y

Cited by 140 publications

(138 citation statements)

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“…2). Dellamonica et al 11. calculated lung strain in 30 volume‐controlled ventilated patients and found that the static strain was higher in patients with high collapse‐prone lungs compared to low recruiters between high and low PEEP.…”

Section: Discussionmentioning

confidence: 99%

Lung stress and strain calculations in mechanically ventilated patients in the intensive care unit

Blankman

Hasan

Bikker

et al. 2015

Acta Anaesthesiol Scand

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BackgroundStress and strain are parameters to describe respiratory mechanics during mechanical ventilation. Calculations of stress require invasive and difficult to perform esophageal pressure measurements. The hypothesis of the present study was: Can lung stress be reliably calculated based on non‐invasive lung volume measurements, during a decremental Positive end‐expiratory pressure (PEEP) trial in mechanically ventilated patients with different diseases?MethodsData of 26 pressure‐controlled ventilated patients admitted to the ICU with different lung conditions were retrospectively analyzed: 11 coronary artery bypass graft (CABG), 9 neurology, and 6 lung disorders. During a decremental PEEP trial (from 15 to 0 cmH2O in three steps) end‐expiratory lung volume (EELV) measurements were performed at each PEEP step, without interruption of mechanical ventilation. Strain, specific elastance, and stress were calculated for each PEEP level. Elastance was calculated as delta PEEP divided by delta PEEP volume, whereas specific elastance is elastance times the FRC. Stress was calculated as specific elastance times the strain. Global strain was divided into dynamic (tidal volume) and static (PEEP) strain.ResultsStrain calculations based on FRC showed mainly changes in static component, whereas calculations based on EELV showed changes in both the static and dynamic component of strain. Stress calculated from EELV measurements was 24.0 ± 2.7 and 13.1 ± 3.8 cmH2O in the lung disorder group at 15 and 5 cmH2O PEEP. For the normal lungs, the stress values were 19.2 ± 3.2 and 10.9 ± 3.3 cmH2O, respectively. These values are comparable to earlier publications. Specific elastance calculations were comparable in patients with neurologic and lung disorders, and lower in the CABG group due to recruitment in this latter group.ConclusionStress and strain can reliably be calculated at the bedside based on non‐invasive EELV measurements during a decremental PEEP trial in patients with different diseases.

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Section: Discussionmentioning

confidence: 99%

Lung stress and strain calculations in mechanically ventilated patients in the intensive care unit

Blankman

Hasan

Bikker

et al. 2015

Acta Anaesthesiol Scand

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“…The value of EELV to assess PEEP response might be improved if it is combined with measurement of compliance. 86,87 Compliance can be used to estimate the increase in EELV if no recruitment occurs. For example, if the compliance is 30 mL/cm H 2 O, one can predict an increase in EELV of 150 mL if PEEP is increased from 5 cm H 2 O to 10 cm H 2 O.…”

Section: Lung Volumementioning

confidence: 99%

Recruitment Maneuvers and PEEP Titration

2015

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The injurious effects of alveolar overdistention are well accepted, and there is little debate regarding the importance of pressure and volume limitation during mechanical ventilation. The role of recruitment maneuvers is more controversial. Alveolar recruitment is desirable if it can be achieved, but the potential for recruitment is variable among patients with ARDS. A stepwise recruitment maneuver, similar to an incremental PEEP titration, is favored over sustained inflation recruitment maneuvers. Many approaches to PEEP titration have been proposed, and the best method to choose the most appropriate level for an individual patient is unclear. A PEEP level should be selected that balances alveolar recruitment against overdistention. The easiest approach to select PEEP might be according to the severity of the disease: 5-10 cm H 2 O PEEP in mild ARDS, 10 -15 cm H 2 O PEEP in moderate ARDS, and 15-20 cm H 2 O PEEP in severe ARDS. Recruitment maneuvers and PEEP should be used within the context of lung protection and not just as a means of improving oxygenation.

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“…Therefore, the method may require a long time before it can be used routinely at the bedside, justifying the development of alternative options. [2][3][4] More than 20 years ago, Ranieri et al showed that PEEPinduced lung recruitment could be assessed by performing static PV curves and measuring end-expiratory lung volume corresponding to different PEEP levels. 5 Use of PV curves for measuring recruitment in patients with ARDS relies on a strong rationale.…”

Section: See the Original Study On Page 416mentioning

confidence: 99%

Measurement of Alveolar Recruitment at the Bedside: The Beginning of a New Era in Respiratory Monitoring?

et al. 2013

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PEEP-induced changes in lung volume in acute respiratory distress syndrome. Two methods to estimate alveolar recruitment

Abstract: PEEP-induced recruitment and strain can be assessed at the bedside using EELV measurement. We describe two bedside methods for predicting low or high alveolar recruitment during ARDS.

Cited by 140 publications

References 32 publications

Lung stress and strain calculations in mechanically ventilated patients in the intensive care unit

Lung stress and strain calculations in mechanically ventilated patients in the intensive care unit

Recruitment Maneuvers and PEEP Titration

Measurement of Alveolar Recruitment at the Bedside: The Beginning of a New Era in Respiratory Monitoring?

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