The open lung during small tidal volume ventilation: Concepts of recruitment and "optimal" positive end-expiratory pressure

Rimensberger, Peter C.; Cox, Patrick; Frndova, Helena; Bryan, A. C.

doi:10.1097/00003246-199909000-00038

Cited by 239 publications

(147 citation statements)

References 32 publications

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“…PEEP also has the potential to modulate the effect of a DI by preventing at least some parts of the lung from ever falling below their critical closing pressures (21,28). The role of the RM is then to reach the higher critical opening pressures for segments not opened during normal tidal inflations (6,23).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, if the effects of a RM are transient, then its apparent benefits will depend on when they are measured. Different researchers have measured the effects of a RM at different time points after its administration (3,4,17,26,28), yet there has been little attempt to characterize the rate at which the benefits of a RM are lost in the period immediately after its delivery.The goal of our study, therefore, was to characterize the effects of a DI on lung mechanics during conventional mechanical ventilation in a mouse model of lung injury. We followed a measure of respiratory elastance (H) as an index of ongoing derecruitment after DI, both at baseline and after saline lavage at various levels of PEEP.…”

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Transient mechanical benefits of a deep inflation in the injured mouse lung

Allen

Lundblad

Parsons

et al. 2002

Journal of Applied Physiology

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Allen, Gilman, Lennart K. A. Lundblad, Polly Parsons, and Jason H. T. Bates. Transient mechanical benefits of a deep inflation in the injured mouse lung. J Appl Physiol 93: 1709-1715. First published July 12, 2002 10.1152/japplphysiol.00473.2002The lasting effects of a recruitment maneuver (RM) in the injured lung are not well characterized. We speculated that the reduction in respiratory elastance (H) after a deep inflation (DI) is transient in nature and should be sustained longer at higher positive end-expiratory pressure (PEEP). Thirteen ventilated mice were given 2 DIs at various levels of PEEP before and after saline lavage. Forced oscillations were used to measure H periodically over 7 min after the DIs. Time constants ( ) were estimated for the post-DI recovery in H. Values for before lavage (80-115 s) were reduced after lavage (13-30 s) at all levels of PEEP (P ϭ 0.0001). PEEP did not significantly influence before or after lavage. The plateau level and total recovery in H after a DI were significantly influenced by PEEP and lavage (P Ͻ 0.0001). Our results suggest that for a DI to be beneficial in the injured mouse lung, it may have to be applied several times a minute. atelectasis; acute lung injury; recruitment; elastance; positive-pressure respiration PHYSICIANS HAVE KNOWN for a long time that atelectasis plays a pivotal role in the development of hypoxemia during mechanical ventilation, both in general anesthesia for routine surgery and in various instances of acute lung injury. Recent practice has now moved toward the use of lower tidal volumes (VT) in patients with acute lung injury and acute respiratory distress syndrome (ARDS) after two important studies demonstrated lower mortality outcomes by using this strategy (1, 1a). However, because of the progressive alveolar derecruitment that is often encountered with the use of lower VT (27), there has been a renewed interest in the use of recruitment maneuvers (RMs) as a means of reopening these regions of atelectasis. Many studies have demonstrated improvement in oxygenation, respiratory system compliance, and even lung volume after sustained or deep inflations (DIs) in many different scenarios (3-5, 17, 18, 26, 28), but some of these same studies were unable to show any lasting improvement when RMs were delivered during conventional positive pressure ventilation (4,18,25).These apparently conflicting results may be explained by the different experimental situations involved, as the effect of a RM is likely to depend on the size and duration of the inflation, the mode of ventilation in which the inflation is delivered, and the level of positive end-expiratory pressure (PEEP) employed. Furthermore, if the effects of a RM are transient, then its apparent benefits will depend on when they are measured. Different researchers have measured the effects of a RM at different time points after its administration (3,4,17,26,28), yet there has been little attempt to characterize the rate at which the benefits of a RM are lost in the period immediately after ...

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Section: Discussionmentioning

confidence: 99%

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Transient mechanical benefits of a deep inflation in the injured mouse lung

Allen

Lundblad

Parsons

et al. 2002

Journal of Applied Physiology

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“…This usually allows a safe insertion of videothoracoscopic instrumentation and easy surgical manipulations, without the need of lung exclusion devices and/or intrapleural CO 2 insufflation. Furthermore, we have noted that even though spontaneous ventilation is maintained, the operated lung remains practically motionless, likely because of some hysteresis establishing after lung collapse [32,33]. In the vast majority of patients, surgical pneumothorax is well tolerated, and does not give raise to clinically relevant gas-exchange impairment.…”

Section: Pitfalls and Complicationsmentioning

confidence: 97%

Nonintubated Videothoracoscopic Operations in Thoracic Oncology

Mineo¹,

Tacconi²

2014

J de Chirurgie

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“…Existe una amplia evidencia experimental de los efectos lesivos del colapso incluso con el empleo de volúmenes corrientes bajos. Sin embargo, éstos pueden atenuarse mediante la aplicación de niveles de pEEp más altos 14,15 o revirtiendo el colapso mediante reclutamiento y la aplicación de pEEp 16 . A nivel clínico, Gattinoni et al 13 han mostrado que los pacientes con mayor proporción de tejido pulmonar no aireado en la tomografía computarizada (TC) presentan un mayor deterioro funcional y una mayor mortalidad.…”

Section: Fundamento De Las Maniobras De Reclutamiento En El Sdraunclassified

Utilidad de las maniobras de reclutamiento (PRO)

Sipmann

2009

Medicina Intensiva

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The open lung during small tidal volume ventilation: Concepts of recruitment and "optimal" positive end-expiratory pressure

Cited by 239 publications

References 32 publications

Transient mechanical benefits of a deep inflation in the injured mouse lung

Transient mechanical benefits of a deep inflation in the injured mouse lung

Nonintubated Videothoracoscopic Operations in Thoracic Oncology

Utilidad de las maniobras de reclutamiento (PRO)

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