Regional Effects and Mechanism of Positive End-Expiratory Pressure in Early Adult Respiratory Distress Syndrome

Gattinoni, Luciano; D’Andrea, Luca; Pelosi, Paolo; Vitale, Giovanni; Pesenti, Antonio; Fumagalli, Roberto

doi:10.1001/jama.1993.03500160092039

Cited by 388 publications

(109 citation statements)

References 20 publications

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“…The increased superimposed pressure is the main mechanism of lung collapse in ARDS, and the PEEP works by counteracting the superimposed pressure [4]; in a healthy subject under anesthesia, therefore, a PEEP value ≤5 cmH 2 O should be sufficient to prevent the development dorsal atelectasies [18]. …”

Section: Discussionmentioning

confidence: 99%

“…When helical CT is performed at different lung volumes/pressures it is also possible to explore the behavior of each tissue compartment using the lung pressure-volume curve [3]. This approach lead to pivotal advancements in the understanding of ARDS pathophysiology, such as the mechanisms of positive end-expiratory pressure (PEEP) [4] and prone positioning [5]. …”

Section: Introductionmentioning

confidence: 99%

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Limits of normality of quantitative thoracic CT analysis

et al. 2013

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IntroductionAlthough computed tomography (CT) is widely used to investigate different pathologies, quantitative data from normal populations are scarce. Reference values may be useful to estimate the anatomical or physiological changes induced by various diseases.MethodsWe analyzed 100 helical CT scans taken for clinical purposes and referred as nonpathological by the radiologist. Profiles were manually outlined on each CT scan slice and each voxel was classified according to its gas/tissue ratio. For regional analysis, the lungs were divided into 10 sterno-vertebral levels.ResultsWe studied 53 males and 47 females (age 64 ± 13 years); males had a greater total lung volume, lung gas volume and lung tissue. Noninflated tissue averaged 7 ± 4% of the total lung weight, poorly inflated tissue averaged 18 ± 3%, normally inflated tissue averaged 65 ± 8% and overinflated tissue averaged 11 ± 7%. We found a significant correlation between lung weight and subject's height (P <0.0001, r2 = 0.49); the total lung capacity in a supine position was 4,066 ± 1,190 ml, ~1,800 ml less than the predicted total lung capacity in a sitting position. Superimposed pressure averaged 2.6 ± 0.5 cmH2O.ConclusionSubjects without lung disease present significant amounts of poorly inflated and overinflated tissue. Normal lung weight can be predicted from patient's height with reasonable confidence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Limits of normality of quantitative thoracic CT analysis

et al. 2013

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“…Ideally, one should apply ventilatory strategies that are relatively non-injurious, but in patients with severe ARDS this might be extremely difficult, if not impossible, because of the spatial heterogeneity of their lung disease [23]. A strategy that maintains a given lung unit open might lead to the overdistension of other units.…”

Section: Implications Of the Ardsnet Trialmentioning

confidence: 99%

Mechanical ventilation: lessons from the ARDSNet trial

2000

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The acute respiratory distress syndrome (ARDS) is an inflammatory disease of the lungs characterized clinically by bilateral pulmonary infiltrates, decreased pulmonary compliance and hypoxemia. Although supportive care for ARDS seems to have improved over the past few decades, few studies have shown that any treatment can decrease mortality for this deadly syndrome. In the 4 May 2000 issue of New England Journal of Medicine, the results of an NIH-sponsored trial were presented; they demonstrated that the use of a ventilatory strategy that minimizes ventilator-induced lung injury leads to a 22% decrease in mortality. The implications of this study with respect to clinical practice, further ARDS studies and clinical research in the critical care setting are discussed. The electronic version of this article can be found online at http://respiratory-research.com/content/1/2/073 © Current Science Ltd (Print ISSN 1465-9921; Online ISSN 1465-993X) ARDS = acute respiratory distress syndrome; HFV = high-frequency ventilation; ICU = intensive care unit; MSOF = multiple system organ failure; PBW = predicted body weight; PEEP = positive end-expiratory pressure; P plat = plateau pressure; VILI = ventilator-induced lung injury; V t = tidal volume.

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“…Chest CT showing posterior consolidation is only an indication for prone positioning, which will recruit posterior lung units when recovery begins and is evident on respiratory support with ECMO. [36][37][38] Other organ systems Skin and general care for pressure points and invasive lines should be taken to prevent skin trauma and breakdown. Antibiotic prophylaxis and treatment are to be administered as per the institution's protocol.…”

Section: Monitoring On Extracorporeal Membrane Oxygenationmentioning

confidence: 99%

Extracorporeal membrane oxygenation - An anesthesiologist′s perspective - Part II: Clinical and technical consideration

Chauhan

Subin

2012

Ann Card Anaesth

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Although the concept of extracorporeal membrane oxygenation (ECMO) has remained unchanged, component technology has evolved considerably over the past three decades. Presently the clinical conditions requiring ECMO support have been updated with input from the outcome data of patient registries. Modern circuit configuration has become less cumbersome, safer, and more efficient. Technological advances now allow prolonged support with fewer complications compared to the past eras and facilitate transition to a single bedside caregiver model, similar to hemofiltration or ventricular-assist devices. The clinical considerations and indicators for placing the patient on ECMO, the various circuit configurations, clinical and technical issues, and management aspects are considered in this article.

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Regional Effects and Mechanism of Positive End-Expiratory Pressure in Early Adult Respiratory Distress Syndrome

Cited by 388 publications

References 20 publications

Limits of normality of quantitative thoracic CT analysis

Limits of normality of quantitative thoracic CT analysis

Mechanical ventilation: lessons from the ARDSNet trial

Extracorporeal membrane oxygenation - An anesthesiologist′s perspective - Part II: Clinical and technical consideration

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