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derecruitment and ards

E Baedorf Kassis, S H Loring, D Talmor
Esophageal manometry has traditionally been utilized for respiratory physiology research, but clinicians have recently found numerous applications within the intensive care unit. Esophageal pressure (PEs ) is a surrogate for pleural pressures (PPl ), and the difference between airway pressure (PAO ) and PEs provides a good estimate for the pressure across the lung also known as the transpulmonary pressure (PL ). Differentiating the effects of mechanical ventilation and spontaneous breathing on the respiratory system, chest wall, and across the lung allows for improved personalization in clinical decision making...
February 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Bradford J Smith, Elizabeth Bartolak-Suki, Bela Suki, Gregory S Roy, Katharine L Hamlington, Chantel M Charlebois, Jason H T Bates
Mechanical ventilation is vital to the management of acute respiratory distress syndrome, but it frequently leads to ventilator-induced lung injury (VILI). Understanding the pathophysiological processes involved in the development of VILI is an essential prerequisite for improving lung-protective ventilation strategies. The goal of this study was to relate the amount and nature of material accumulated in the airspaces to biomarkers of injury and the derecruitment behavior of the lung in VILI. Forty-nine BALB/c mice were mechanically ventilated with combinations of tidal volume and end-expiratory pressures to produce varying degrees of overdistension and atelectasis while lung function was periodically assessed...
2017: Frontiers in Physiology
Lu Chen, Guang-Qiang Chen, Kevin Shore, Orest Shklar, Concetta Martins, Brian Devenyi, Paul Lindsay, Heather McPhail, Ashley Lanys, Ibrahim Soliman, Mazin Tuma, Michael Kim, Kerri Porretta, Pamela Greco, Hilary Every, Chris Hayes, Andrew Baker, Jan O Friedrich, Laurent Brochard
BACKGROUND: Despite their potential interest for clinical management, measurements of respiratory mechanics in patients with acute respiratory distress syndrome (ARDS) are seldom performed in routine practice. We introduced a systematic assessment of respiratory mechanics in our clinical practice. After the first year of clinical use, we retrospectively assessed whether these measurements had any influence on clinical management and physiological parameters associated with clinical outcomes by comparing their value before and after performing the test...
April 4, 2017: Critical Care: the Official Journal of the Critical Care Forum
Gary F Nieman, Joshua Satalin, Penny Andrews, Hani Aiash, Nader M Habashi, Louis A Gatto
It has been shown that mechanical ventilation in patients with, or at high-risk for, the development of acute respiratory distress syndrome (ARDS) can be a double-edged sword. If the mechanical breath is improperly set, it can amplify the lung injury associated with ARDS, causing a secondary ventilator-induced lung injury (VILI). Conversely, the mechanical breath can be adjusted to minimize VILI, which can reduce ARDS mortality. The current standard of care ventilation strategy to minimize VILI attempts to reduce alveolar over-distension and recruitment-derecruitment (R/D) by lowering tidal volume (Vt) to 6 cc/kg combined with adjusting positive-end expiratory pressure (PEEP) based on a sliding scale directed by changes in oxygenation...
December 2017: Intensive Care Medicine Experimental
Gregory A Schmidt
The foundation of mechanical ventilation for acute respiratory distress syndrome involves limiting lung overdistention by using small tidal volumes or transpulmonary pressures. Potential for additional lung recruitment with higher positive end-expiratory pressure (PEEP) should be assessed. When stress index indicates tidal recruitment-derecruitment, PEEP is increased to higher values. Alternatively, a high PEEP table is used in all patients. When these conventional approaches are insufficient to sustain acceptable gas exchange, rescue is attempted using extracorporeal therapies, airway pressure-release ventilation, inhaled vasodilators, or high-frequency oscillatory ventilation...
December 2016: Clinics in Chest Medicine
Reza Amini, Jacob Herrmann, David W Kaczka
GOAL: Ventilated patients with the acute respiratory distress syndrome (ARDS) are predisposed to cyclic parenchymal overdistention and derecruitment, which may worsen existing injury. We hypothesized that intratidal variations in global mechanics, as assessed at the airway opening, would reflect such distributed processes. METHODS: We developed a computational lung model for determining local instantaneous pressure distributions and mechanical impedances continuously during a breath...
March 2017: IEEE Transactions on Bio-medical Engineering
Songqiao Liu, Li Tan, Knut Möller, Inez Frerichs, Tao Yu, Ling Liu, Yingzi Huang, Fengmei Guo, Jingyuan Xu, Yi Yang, Haibo Qiu, Zhanqi Zhao
BACKGROUND: Information on regional ventilation distribution in mechanically ventilated patients is important to develop lung protective ventilation strategies. In the present prospective animal study, we introduce an electrical impedance tomography (EIT)-based method to classify lungs into normally ventilated, overinflated, tidally recruited/derecruited and recruited regions. METHODS: Acute respiratory distress syndrome (ARDS) was introduced with repeated bronchoalveolar lavage in ten healthy male pigs until the ratio of arterial partial pressure of oxygen and fraction of inspired oxygen (PaO2/FiO2) decreased to less than 100 mmHg and remained stable for 30 minutes...
May 3, 2016: Critical Care: the Official Journal of the Critical Care Forum
Toru Kotani, Hitoshi Tanabe, Hiroaki Yusa, Satoshi Saito, Kenji Yamazaki, Makoto Ozaki
Electrical impedance tomography (EIT) is a noninvasive technique used to assess regional gas distribution in the lung. We experienced a patient with acute cor pulmonale during high positive-pressure ventilation for the treatment of severe acute respiratory distress syndrome. Prone positioning was beneficial for unloading the right ventricle for treatment of acute cor pulmonale. EIT played a role in detecting lung derecruitment at the patient's bedside. Impedance distribution in ventral, mid-ventral, mid-dorsal, and dorsal layers before and 20 min after the start of prone positioning was 9, 48, 44, and 0 %, and 10, 25, 48, and 16 %, respectively...
February 2016: Journal of Anesthesia
Penny L Andrews, Benjamin Sadowitz, Michaela Kollisch-Singule, Joshua Satalin, Shreyas Roy, Kathy Snyder, Louis A Gatto, Gary F Nieman, Nader M Habashi
BACKGROUND: Improperly set mechanical ventilation (MV) with normal lungs can advance lung injury and increase the incidence of acute respiratory distress syndrome (ARDS). A key mechanism of ventilator-induced lung injury (VILI) is an alteration in alveolar mechanics including alveolar instability or recruitment/derecruitment (R/D). We hypothesize that R/D cannot be identified by PaO2 (masking occult VILI), and if protective ventilation is not applied, ARDS incidence will increase. METHODS: Sprague-Dawley rats (n = 8) were anesthetized, surgically instrumented, and placed on MV...
December 2015: Intensive Care Medicine Experimental
J Retamal, G Bugedo, A Larsson, A Bruhn
BACKGROUND: Positive end-expiratory pressure (PEEP) improves gas exchange and respiratory mechanics, and it may decrease tissue injury and inflammation. The mechanisms of this protective effect are not fully elucidated. Our aim was to determine the intrinsic effects of moderate and higher levels of PEEP on tidal recruitment/derecruitment, hyperinflation, and lung mechanics, in patients with acute respiratory distress syndrome (ARDS). METHODS: Nine patients with ARDS of mainly pulmonary origin were ventilated sequential and randomly using two levels of PEEP: 9 and 15 cmH2 O, and studied with dynamic computed tomography at a fix transversal lung region...
October 2015: Acta Anaesthesiologica Scandinavica
Yun Long, Da-Wei Liu, Huai-Wu He, Zhan-Qi Zhao
BACKGROUND: Electrical impedance tomography (EIT) is a real-time bedside monitoring tool, which can reflect dynamic regional lung ventilation. The aim of the present study was to monitor regional gas distribution in patients with acute respiratory distress syndrome (ARDS) during positive-end-expiratory pressure (PEEP) titration using EIT. METHODS: Eighteen ARDS patients under mechanical ventilation in Department of Critical Care Medicine of Peking Union Medical College Hospital from January to April in 2014 were included in this prospective observational study...
June 5, 2015: Chinese Medical Journal
Junko Kamiyama, Subrina Jesmin, Hideaki Sakuramoto, Nobutake Shimojyo, Majedul Islam, Keiichi Hagiya, Masato Sugano, Takeshi Unoki, Masami Oki, Satoru Kawano, Taro Mizutani
BACKGROUND: Hyperinflation (HI) is performed following open endotracheal suctioning (OES), whose goals include: to stimulate a cough, recover oxygenation and improve compliance. However, it may also induce unintended consequences, including: lung stress and strain, failure to maintain high distending pressure, and subsequently cycling recruitment and derecruitment. Here, our aim was to investigate the effects of hyperinflation after repeated OES on sequential alteration of arterial oxygenation and lung injury profile using a saline lavage-induced surfactant depleted ARDS rabbit model...
2015: BMC Anesthesiology
Bradford J Smith, Lennart K A Lundblad, Michaela Kollisch-Singule, Joshua Satalin, Gary Nieman, Nader Habashi, Jason H T Bates
Mechanical ventilation is a crucial component of the supportive care provided to patients with acute respiratory distress syndrome. Current practice stipulates the use of a low tidal volume (VT) of 6 ml/kg ideal body weight, the presumptive notion being that this limits overdistension of the tissues and thus reduces volutrauma. We have recently found, however, that airway pressure release ventilation (APRV) is efficacious at preventing ventilator-induced lung injury, yet APRV has a very different mechanical breath profile compared with conventional low-VT ventilation...
April 1, 2015: Journal of Applied Physiology
Ricardo Valentini, José Aquino-Esperanza, Ignacio Bonelli, Patricio Maskin, Mariano Setten, Florencia Danze, Shiry Attie, Pablo O Rodriguez
PURPOSE: The purpose of the study was to compare gas exchange and lung mechanics between different strategies to select positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome (ARDS). METHODS: In 20 consecutive ARDS patients, 3 PEEP selection strategies were evaluated. One strategy was based on oxygenation using the ARDS network PEEP/fraction of inspired oxygen (Fio2) table; and two were based on lung mechanics, either PEEP titrated to reach a plateau pressure of 28 to 30 cm H2O as in the ExPress trial or best respiratory compliance method during a derecruitment maneuver...
April 2015: Journal of Critical Care
Stefan Boehme, Alexander H Bentley, Erik K Hartmann, Shi Chang, Gabor Erdoes, Anatol Prinzing, Michael Hagmann, James E Baumgardner, Roman Ullrich, Klaus Markstaller, Matthias David
OBJECTIVE: Cyclic recruitment and derecruitment of atelectasis can occur during mechanical ventilation, especially in injured lungs. Experimentally, cyclic recruitment and derecruitment can be quantified by respiration-dependent changes in PaO2 (ΔPaO2), reflecting the varying intrapulmonary shunt fraction within the respiratory cycle. This study investigated the effect of inspiration to expiration ratio upon ΔPaO2 and Horowitz index. DESIGN: Prospective randomized study...
March 2015: Critical Care Medicine
Bradford J Smith, Jason H T Bates
Mechanical ventilation of patients with acute respiratory distress syndrome (ARDS) is a necessary life support measure which may lead to ventilator-induced lung injury, a complication that can be reduced or ameliorated by using appropriate tidal volumes and positive end-expiratory pressures. However, the optimal mechanical ventilation parameters are almost certainly different for each patient, and will vary with time as the injury status of the lung changes. In order to optimize mechanical ventilation in an individual ARDS patient, therefore, it is necessary to track the manner in which injury status is reflected in the mechanical properties of the lungs...
September 2015: IEEE Transactions on Bio-medical Engineering
Hideaki Sakuramoto, Nobutake Shimojo, Subrina Jesmin, Takeshi Unoki, Junko Kamiyama, Masami Oki, Ken Miya, Satoru Kawano, Taro Mizutani
BACKGROUND: Although endotracheal suctioning induces alveolar derecruitment during mechanical ventilation, it is not clear whether repeated endotracheal suctioning exacerbates lung injuries. The present study aimed to determine whether repeated open endotracheal suctioning (OS) exacerbates lung injury compared to closed endotracheal suctioning (CS) during mechanical ventilation in an animal model of acute respiratory distress syndrome (ARDS). METHODS: Briefly, thirty six Japanese white rabbits were initially ventilated in pressure-controlled mode with a constant tidal volume (6 mL/kg)...
2013: BMC Anesthesiology
Luciano Gattinoni, Paolo Taccone, Eleonora Carlesso, John J Marini
In the prone position, computed tomography scan densities redistribute from dorsal to ventral as the dorsal region tends to reexpand while the ventral zone tends to collapse. Although gravitational influence is similar in both positions, dorsal recruitment usually prevails over ventral derecruitment, because of the need for the lung and its confining chest wall to conform to the same volume. The final result of proning is that the overall lung inflation is more homogeneous from dorsal to ventral than in the supine position, with more homogeneously distributed stress and strain...
December 1, 2013: American Journal of Respiratory and Critical Care Medicine
Hye Yun Park, Sang Yun Ha, Shin Hye Lee, Saji Kim, Keun-Shik Chang, Kyeongman Jeon, Sang-Won Um, Won-Jung Koh, Gee Young Suh, Man Pyo Chung, Joungho Han, Hojoong Kim, O Jung Kwon
OBJECTIVES: The aim of our study was to assess whether repeated derecruitments induced by the repetitive withdrawal of high positive end-expiratory pressure could induce lung injury in a swine model. DESIGN: Prospective, randomized, experimental animal study. SETTING: University laboratory. SUBJECTS: Specific pathogen-free pigs (Choong-Ang Laboratory Animals, Seoul, Korea) weighing around 30 kg. INTERVENTIONS: After lung injury was induced by repeated saline lavage, pigs were ventilated in pressure-limited mode with the highest possible positive end-expiratory pressure with a tidal volume of 8 mL/kg and maximum inspiratory pressure of 30 cm H2O...
December 2013: Critical Care Medicine
Guillermo Bugedo, Alejandro Bruhn, Tomás Regueira, Carlos Romero, Jaime Retamal, Glenn Hernández
OBJECTIVE: The objective of this study was to assess the effects of positive end-expiratory pressure on recruitment, cyclic recruitment and derecruitment and strain in patients with acute lung injury and acute respiratory distress syndrome using lung computed tomography. METHODS: This is an open, controlled, non-randomized interventional study of ten patients with acute lung injury and acute respiratory distress syndrome. Using computed tomography, single, basal slices of the lung were obtained during inspiratory and expiratory pauses at a tidal volume of 6 ml/kg and a positive end-expiratory pressure of 5, 10, 15 and 20 cmH2O...
March 2012: Revista Brasileira de Terapia Intensiva
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