Effects of periodic lung recruitment maneuvers on gas exchange and respiratory mechanics in mechanically ventilated acute respiratory distress syndrome (ARDS) patients

被引:149
作者
Foti, G [1 ]
Cereda, M [1 ]
Sparacino, ME [1 ]
De Marchi, L [1 ]
Villa, F [1 ]
Pesenti, A [1 ]
机构
[1] Univ Milan, Nuovo Osped S Gerardo dei Tintori, Dept Anesthesia & Intens Care, I-20052 Milan, Italy
关键词
positive end-expiratory pressure; mechanical ventilation; barotrauma prevention; alveolar recruitment; acute respiratory distress syndrome (ARDS);
D O I
10.1007/s001340051196
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: We wished to investigate whether volume recruitment maneuvers (VRMs) could improve alveolar recruitment and oxygenation in acute respiratory distress syndrome (ARDS) patients, ventilated at relatively low positive end-expiratory pressure (PEEP). Setting: General intensive care unit (ICU) located in a teaching hospital. Patients: 15 PEEP responder ARDS patients undergoing continuous positive pressure ventilation (CPPV) with sedation and muscle paralysis. Interventions: We identified a low (9.4 +/- 3 cmH(2)O) and a high (16.0 +/- 2 cmH(2)O) level of PEEP associated with target oxygenation values. Using a custom modified mechanical ventilator, we applied in random order three steps lasting 30 min: (1) CPPV at the low PEEP level (CPPVLo); (2) CPPV at the high PEEP level (CPPVHI); (3) CPPV at low PEEP with the superimposition of periodic VRMs (CPPVVRM). VRMs were performed twice a minute by increasing PEEP to the high level for two breaths. Each brace of two breaths was spaced 30 seconds from the preceding one. Measurements and results: We measured gas exchange, hemodynamics, respiratory mechanics, and the end expiratory lung volume (EELV). Compared to CPPVLo, CPPVVRM resulted in higher PaO2 (117.9 +/- 40.6 vs 79.4 +/- 13.6 mmHg, P < 0.01) and EELV (1.50 +/- 0.62 vs 1.26 +/- 0.50 l, P < 0.05), and in lower venous admixture (QVA/QT) (0.42 +/- 0.07 vs 0.48 +/- 0.07, P < 0.01). During CPPVHI, we observed significantly higher PaO2 (139.3 +/- 32.5 mmHg) and lower QVA/QT (0.37 +/- 0.08) compared to CPPVLo (P < 0.01) and to CPPVVRM (P < 0.05). Conclusions: VRMs can improve oxygenation and alveolar recruitment during CPPV at relatively low PEEP, but are relatively less effective than a continuous high PEEP level.
引用
收藏
页码:501 / 507
页数:7
相关论文
共 32 条
[1]  
Altman DG, 1990, PRACTICAL STAT MED R
[2]   Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome [J].
Amato, MBP ;
Barbas, CSV ;
Medeiros, DM ;
Magaldi, RB ;
Schettino, GDP ;
Lorenzi, G ;
Kairalla, RA ;
Deheinzelin, D ;
Munoz, C ;
Oliveira, R ;
Takagaki, TY ;
Carvalho, CRR .
NEW ENGLAND JOURNAL OF MEDICINE, 1998, 338 (06) :347-354
[3]   IMPAIRED OXYGENATION IN SURGICAL PATIENTS DURING GENERAL ANESTHESIA WITH CONTROLLED VENTILATION - A CONCEPT OF ATELECTASIS [J].
BENDIXEN, HH ;
HEDLEYWHYTE, J ;
LAVER, MB .
NEW ENGLAND JOURNAL OF MEDICINE, 1963, 269 (19) :991-+
[4]   THE AMERICAN-EUROPEAN CONSENSUS CONFERENCE ON ARDS - DEFINITIONS, MECHANISMS, RELEVANT OUTCOMES, AND CLINICAL-TRIAL COORDINATION [J].
BERNARD, GR ;
ARTIGAS, A ;
BRIGHAM, KL ;
CARLET, J ;
FALKE, K ;
HUDSON, L ;
LAMY, M ;
LEGALL, JR ;
MORRIS, A ;
SPRAGG, R ;
COCHIN, B ;
LANKEN, PN ;
LEEPER, KV ;
MARINI, J ;
MURRAY, JF ;
OPPENHEIMER, L ;
PESENTI, A ;
REID, L ;
RINALDO, J ;
VILLAR, J ;
VANASBECK, BS ;
DHAINAUT, JF ;
MANCEBO, J ;
MATTHAY, M ;
MEYRICK, B ;
PAYEN, D ;
PERRET, C ;
FOWLER, AA ;
SCHALLER, MD ;
HUDSON, LD ;
HYERS, T ;
KNAUS, W ;
MATTHAY, R ;
PINSKY, M ;
BONE, RC ;
BOSKEN, C ;
JOHANSON, WG ;
LEWANDOWSKI, K ;
REPINE, J ;
RODRIGUEZROISIN, R ;
ROUSSOS, C ;
ANTONELLI, MA ;
BELOUCIF, S ;
BIHARI, D ;
BURCHARDI, H ;
LEMAIRE, F ;
MONTRAVERS, P ;
PETTY, TL ;
ROBOTHAM, J ;
ZAPOL, W .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1994, 149 (03) :818-824
[5]   PULMONARY DENSITIES DURING ANESTHESIA WITH MUSCULAR RELAXATION - A PROPOSAL OF ATELECTASIS [J].
BRISMAR, B ;
HEDENSTIERNA, G ;
LUNDQUIST, H ;
STRANDBERG, A ;
SVENSSON, L ;
TOKICS, L .
ANESTHESIOLOGY, 1985, 62 (04) :422-428
[6]  
BROSEGHINI C, 1988, EUR RESPIR J, V1, P726
[7]   Positive end-expiratory pressure prevents the loss of respiratory compliance during low tidal volume ventilation in acute lung injury patients [J].
Cereda, M ;
Foti, G ;
Musch, G ;
Sparacino, ME ;
Pesenti, A .
CHEST, 1996, 109 (02) :480-485
[8]   HIGH INFLATION PRESSURE PULMONARY-EDEMA - RESPECTIVE EFFECTS OF HIGH AIRWAY PRESSURE, HIGH TIDAL VOLUME, AND POSITIVE END-EXPIRATORY PRESSURE [J].
DREYFUSS, D ;
SOLER, P ;
BASSET, G ;
SAUMON, G .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1988, 137 (05) :1159-1164
[9]   INTERMITTENT DEEP BREATHS AND COMPLIANCE DURING ANESTHESIA IN MAN [J].
EGBERT, LD ;
BENDIXEN, HH ;
LAVER, MB .
ANESTHESIOLOGY, 1963, 24 (01) :57-+
[10]  
Fairley H B, 1976, Respir Care, V21, P1127