The Relation of Pneumothorax and Other Air Leaks to Mortality in the Acute Respiratory Distress Syndrome

Weg, John G.; Anzueto, Antonio; Balk, R.A.; Wiedemann, Herbert; Pattishall, Edward N.; Schork, M. Anthony; Wagner, Leslie A.

doi:10.1097/00132586-199812000-00009

Cited by 12 publications

(16 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…22 In addition, there was no correlation between 'high' ventilatory pressures and the development of pneumothorax or other air leaks in patients with sepsis-induced acute respiratory distress syndrome. 23 Thus it is difficult, if not impossible, to draw firm conclusions from these findings with respect to the risk of barotrauma caused by hyperinflation in adults with healthy lungs. The VC manoeuvre used in our study resulted in a volume not larger than vital capacity in the awake, supine subject.…”

Section: Discussionmentioning

confidence: 98%

Dynamics of re-expansion of atelectasis during general anaesthesia

Rothen

Neumann

Berglund

et al. 1999

British Journal of Anaesthesia

199

110

View full text Add to dashboard Cite

A major cause of impaired gas exchange during general anaesthesia is atelectasis, causing pulmonary shunt. A 'vital capacity' (VC) manoeuvre (i.e. inflation of the lungs up to 40 cm H 2 O, maintained for 15 s) may re-expand atelectasis and improve oxygenation. However, such a manoeuvre may cause adverse cardiovascular effects. Reducing the time of maximal inflation may improve the margin of safety. The aim of this study was to analyse the change over time in the amount of atelectasis during a VC manoeuvre in 12 anaesthetized adults with healthy lungs. I.v. anaesthesia with controlled mechanical ventilation (VT 9 (SD 1) ml kg -1 ) was used. For the VC manoeuvre, the lungs were inflated up to an airway pressure (Paw) of 40 cm H 2 O. This pressure was maintained for 26 s. Atelectasis was assessed by analysis of computed x-ray tomography. The amount of atelectasis, measured at the base of the lungs, was 4.0 (SD 2.7) cm 2 after induction of anaesthesia. The decrease in the amount of atelectasis over time during the VC manoeuvre was described by a negative exponential function with a time constant of 2.6 s. At an inspired oxygen concentration of 40%, Pa O 2 increased from 17.2 (4.0) kPa before to 22.2 (6.0) kPa (Pϭ0.013) after the VC manoeuvre. Thus in anaesthetized adults undergoing mechanical ventilation with healthy lungs, inflation of the lungs to a Paw of 40 cm H 2 O, maintained for 7-8 s only, may re-expand all previously collapsed lung tissue, as detected by lung computed tomography, and improve oxygenation. We conclude that the previously proposed time for a VC manoeuvre may be halved in such subjects. 1999; 82: 551-6 Br J Anaesth

show abstract

Section: Discussionmentioning

confidence: 98%

Dynamics of re-expansion of atelectasis during general anaesthesia

Rothen

Neumann

Berglund

et al. 1999

British Journal of Anaesthesia

199

110

View full text Add to dashboard Cite

show abstract

“…We defined barotrauma as the presence of air outside the tracheobronchial tree, resulting from presumed alveolar rupture, and manifested as interstitial emphysema, pneumothorax, pneumomediastinum, pneumoperitoneum, or subcutaneous emphysema. 20 Patients who developed barotrauma during the first 24 hours of observation prior to randomization were also excluded, because it was not feasible to measure plateau pressure. In subjects excluded after randomization, the respiratory protocol was not applied, although protective lung ventilation was maintained, and they were kept in their assigned study groups for outcome analysis.…”

Section: Methodsmentioning

confidence: 99%

Individualized PEEP Setting in Subjects With ARDS: A Randomized Controlled Pilot Study

et al. 2013

View full text Add to dashboard Cite

BACKGROUND: Low-tidal-volume ventilation may be associated with repetitive opening and closing of terminal airways. The use of PEEP is intended to keep the alveoli open. No method of adjusting the optimal PEEP has shown to be superior or to improve clinical outcomes. We conducted a pilot study to evaluate the effect of setting an individualized level of PEEP at the highest compliance on oxygenation, multiple-organ-dysfunction, and survival in subjects with ARDS. METHODS: Subjects with ARDS ventilated with low tidal volumes and limitation of airway pressure to 30 cm H 2 O were randomized to either a compliance-guided PEEP group or an F IO 2 -guided group. RESULTS: Of the 159 patients with ARDS admitted during the study period, 70 met the inclusion criteria. Subjects in the compliance-guided group showed nonsignificant improvements in P aO 2 /F IO 2 during the first 14 days, and in 28-day mortality (20.6% vs. 38.9%, P ‫؍‬ .12). Multipleorgan-dysfunction-free days (median 6 vs 20.5 d, P ‫؍‬ .02), respiratory-failure-free days (median 7.5 vs 14.5 d, P ‫؍‬ .03), and hemodynamic-failure-free days (median 16 vs 22 d, P ‫؍‬ .04) at 28 days were significantly lower in subjects with compliance-guided setting of PEEP. CONCLUSIONS: In ARDS subjects, protective mechanical ventilation with PEEP application according to the highest compliance was associated with less organ dysfunction and a strong nonsignificant trend toward lower mortality. ClinicalTrials.gov Number NCT01119872.

show abstract

“…Using a similar imaging approach, PEEP was found to increase the amount of normally inflated lung by recruitment of previously collapsed alveoli 19 and to a significant extent prevent end expiratory de-recruitment. Gross ventilator trauma was examined by Weg and colleagues 20 who failed to find a relationship between this and outcome in a retrospective review of over 700 cases. …”

Section: Effect Of Ventilation Strategy On Outcomementioning

confidence: 99%