Recruitment Maneuvers and Higher PEEP, the So-Called Open Lung Concept, in Patients with ARDS

Zee, Philip van der; Gommers, Diederik

doi:10.1186/s13054-019-2365-1

Cited by 48 publications

(42 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…28 Open lung ventilation (OLV) involves RM and high PEEP administration. 29 Chaney et al 19 do not mention RM in their study and Lellouche et al 20 performed RM after weaning from CPB, Miranda et al 22 applied RM after induction and during the postoperative ICU stay. Therefore, in the last two studies, patients were actually ventilated with the OLV strategy.…”

Section: Discussionmentioning

confidence: 99%

Açık Kalp Cerrahisinde Düşük Tidal Volüm Ventilasyon: 8 ml/kg ve 6 ml/kg Tidal volümden Hangisi Daha İyi?

Çardaközü

Aksu

Arıkan

2021

Kocaeli Üniversitesi Sağlık Bilimleri Dergisi

View full text Add to dashboard Cite

Objective: To compare the outcomes of 6m/kg vs. 8 ml/kg tidal volume in the lung protective ventilation -low tidal volume strategy in coronary artery bypass grafting operation. Methods: Thirty-two patients enrolled in a randomized, single-center, prospective study were divided into two groups. The outcomes of 6m/kg vs. 8 ml/kg were compared. Arterial blood pressures, heart rate, central venous pressure, expired tidal volume, respiratory frequency, the alveolar minute ventilation, the inspiratory time, static compliance, peak airway pressure, plateau pressure, driving pressure, arterial blood gas data and PaCO 2 -EtCO 2 difference were recorded at T 1 (15 min. prior to CPB), T 2 (15 min. following the termination of cardio pulmonary bypass), and T 3 times (at the end of the surgery). PaO 2 /FiO 2 ratio was recorded at T 1 , T 2 and T 3 and 6 th (T 4 ) and 12 th hours (T 5 ) after extubation. Results: In Group 6ml/kg, extubation time and length of stay in the intensive care unit were significantly longer (p<0.001, p=0.001, respectively). Discharge times were similar in both groups. In group 6ml/kg, PaCO 2 was high at all times (T 1 , T 2 , T 3 ; p=0.002, p=0.004, p=0.001, respectively), Hemodynamic changes had a similar course in both groups, in Group 6ml/kg. The PaO 2 /FiO 2 ratio was significantly higher in Group 8ml/kg at T 2 (p=0.009) and similar at other times. Conclusion: Mechanical ventilation with a low tidal volume strategy with 8 ml/kg has more favorable outcomes by considering the shorter extubation time and length of stay in the intensive care unit comparing with 6 ml/kg.

show abstract

Section: Discussionmentioning

confidence: 99%

Açık Kalp Cerrahisinde Düşük Tidal Volüm Ventilasyon: 8 ml/kg ve 6 ml/kg Tidal volümden Hangisi Daha İyi?

Çardaközü

Aksu

Arıkan

2021

Kocaeli Üniversitesi Sağlık Bilimleri Dergisi

View full text Add to dashboard Cite

show abstract

“…Taking into account MV settings, our results showed that ultra-protective ventilation strategy [ 32 ], with significant reductions in V T /IBW (from 5.5 to 4.0 mL/kg), P plat (from 27 to 21 cmH 2 O), ΔP (from 11 to 8 cmH 2 O) and RR (from 22 to 14 breaths/min) was feasible in all patients after ECMO initiation. However, lung ventilation parameters were also within the “protective” ranges before ECMO initiation [ 3 ], with levels of PEEP (from 14 to 13 cmH 2 O) indicating the maintenance of an “open lung” strategy [ 40 , 41 ], even during ECMO. These findings suggest the importance of MP monitoring at the bedside, as lung stress may occur even within acceptable ranges of V T , P plat , and PEEP and might prompt an earlier use of extra-corporeal therapies to reduce the occurrence of VILI.…”

Section: Discussionmentioning

confidence: 99%

“…Other MV parameters that account for MP computation, such as PEEP, V T /IBW, and RR should also be carefully monitored. The lower PEEP values in ICU non-survivors (10 vs. 14 cmH 2 O) could support the open lung strategy [ 40 , 41 , 42 , 43 ]. At the same time, the lower V T /IBW in ICU deaths (3.0 vs. 4.0 mL/kg) might suggest a limit value in V T reduction, even on ECMO [ 9 , 50 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

Mechanical Power during Veno-Venous Extracorporeal Membrane Oxygenation Initiation: A Pilot-Study

et al. 2021

View full text Add to dashboard Cite

Mechanical power (MP) represents a useful parameter to describe and quantify the forces applied to the lungs during mechanical ventilation (MV). In this multi-center, prospective, observational study, we analyzed MP variations following MV adjustments after veno-venous extra-corporeal membrane oxygenation (VV ECMO) initiation. We also investigated whether the MV parameters (including MP) in the early phases of VV ECMO run may be related to the intensive care unit (ICU) mortality. Thirty-five patients with severe acute respiratory distress syndrome were prospectively enrolled and analyzed. After VV ECMO initiation, we observed a significant decrease in median MP (32.4 vs. 8.2 J/min, p < 0.001), plateau pressure (27 vs. 21 cmH2O, p = 0.012), driving pressure (11 vs. 8 cmH2O, p = 0.014), respiratory rate (RR, 22 vs. 14 breaths/min, p < 0.001), and tidal volume adjusted to patient ideal body weight (VT/IBW, 5.5 vs. 4.0 mL/kg, p = 0.001) values. During the early phase of ECMO run, RR (17 vs. 13 breaths/min, p = 0.003) was significantly higher, while positive end-expiratory pressure (10 vs. 14 cmH2O, p = 0.048) and VT/IBW (3.0 vs. 4.0 mL/kg, p = 0.028) were lower in ICU non-survivors, when compared to the survivors. The observed decrease in MP after ECMO initiation did not influence ICU outcome. Waiting for large studies assessing the role of these parameters in VV ECMO patients, RR and MP monitoring should not be underrated during ECMO.

show abstract

“…In the current literature, the application of RM has been a topic of debate. Although the use of the open lung concept has been suggested in refractory hypoxaemia, 23 in a multicentre trial examining the use of RM in moderate to severe ARDS, a strategy that included the systematic use of RM was associated with increased mortality. 24 In addition, RMs were used in 32.7% in patients with severe ARDS, which is slightly less than what was found in our survey.…”

Section: Discussionmentioning

confidence: 99%

A survey on the practices and capabilities in the management of respiratory failure in South East England

Jha

Vasques

Sanderson

et al. 2020

Journal of the Intensive Care Society

View full text Add to dashboard Cite

Introduction The variability of acute respiratory distress syndrome management may affect the referral practice to severe respiratory failure centres. We described the management of acute respiratory distress syndrome in our catchment area. Methods An electronic survey was administered to 42 intensive care units in South-East England. Results Response rate was 71.4%. High-flow nasal oxygen and non-invasive ventilation were used ‘often’ in moderate-acute respiratory distress syndrome by 46.7% and 60%. During invasive ventilation, 90% preferred pressure control, targeting tidal volumes of 6–8 ml/kg (53.3%) or 4–6 ml/kg (46.7%). Positive end-expiratory pressure was selected by positive end-expiratory pressure/inspiratory fraction of oxygen tables (50%) or decremental positive end-expiratory pressure trials (20%). Neuro-muscular blockers were widely used, although routinely by only 3.3%. High-frequency oscillatory ventilation (10%) and inhaled nitric oxide (13.3%) were rarely used. None used oesophageal manometry. Recruitment manoeuvres were used ‘often’ by 26.7%. Equipment (90%) and protocols (80%) for prone position were common, with sessions mostly lasting 12–18 h. Conclusions Although variable, practice well reflected the available evidence. Proning was widely practiced with good availability of educational resources and protocolised care.

show abstract

Recruitment Maneuvers and Higher PEEP, the So-Called Open Lung Concept, in Patients with ARDS

Cited by 48 publications

References 36 publications

Açık Kalp Cerrahisinde Düşük Tidal Volüm Ventilasyon: 8 ml/kg ve 6 ml/kg Tidal volümden Hangisi Daha İyi?

Açık Kalp Cerrahisinde Düşük Tidal Volüm Ventilasyon: 8 ml/kg ve 6 ml/kg Tidal volümden Hangisi Daha İyi?

Mechanical Power during Veno-Venous Extracorporeal Membrane Oxygenation Initiation: A Pilot-Study

A survey on the practices and capabilities in the management of respiratory failure in South East England

Contact Info

Product

Resources

About