1. Effects of the open lung concept following ARDSnet ventilation in patients with early ARDS
- Author
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Carlos Roberto Ribeiro de Carvalho, D Medeiros, Vivian Rotman, Rosana Souza Rodrigues, Eduardo Costa Pinto, Alysson R. Carvalho, and Fernando A. Bozza
- Subjects
Adult ,Male ,medicine.medical_specialty ,ARDS ,Pulmonary Atelectasis ,Acute respiratory distress ,Positive-Pressure Respiration ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Anesthesiology ,medicine ,Humans ,In patient ,Prospective Studies ,Lung ,Aged ,Aged, 80 and over ,Respiratory Distress Syndrome ,Lung -adult respiratory distress syndrome ,business.industry ,Interleukin-6 ,Ventilation – effects ,Interleukin-8 ,030208 emergency & critical care medicine ,respiratory system ,Middle Aged ,Protective Factors ,medicine.disease ,respiratory tract diseases ,medicine.anatomical_structure ,Anesthesiology and Pain Medicine ,030228 respiratory system ,Low tidal volume ,Anesthesia ,Measurement techniques – tomography ,Breathing ,Female ,Blood Gas Analysis ,business ,Tomography, Spiral Computed ,Research Article - Abstract
Background Ventilation with low tidal volume (VT) is well recognized as a protective approach to patients with acute respiratory distress syndrome (ARDS), but the optimal level of positive end-expiratory pressure (PEEP) remains uncertain. This study aims to evaluate two protective ventilatory strategies sequentially applied in patients with early ARDS. Methods In this prospective cohort study, fifteen patients were ventilated during 24 h with positive end-expiratory pressure (PEEP) adjusted according to the ARDSnet low-PEEP table (ARDSnet-24 h). During the next 24 h, nine patients with PaO2/FIO2 ratio below 350 mmHg were ventilated with PEEP titrated according to the Open Lung Concept protocol (ARDSnet + OLC). In the other six patients, regardless of their PaO2/FIO2 ratio, the ARDSnet remained for a further 24 h (ARDSnet-48 h). Ventilatory variables, arterial blood-gas and cytokine were obtained at baseline, 24 and 48 h. Additionally, whole-lung-computed tomography was acquired at 24 and 48 h. Results A sustained improvement in PaO2/FIO2 ratio (P = 0.008) with a decrease in collapsed regions (P = 0.008) was observed in the ARDSnet + OLC group compared with the ARDSnet-24 h group. A reduction in IL-6 in plasma (P
- Published
- 2016