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Optimization of Positive End-Expiratory Pressure by Volumetric Capnography Variables in Lavage-Induced Acute Lung Injury.
- Source :
-
Respiration . Jan2014, Vol. 87 Issue 1, p75-83. 9p. 3 Charts, 4 Graphs. - Publication Year :
- 2014
-
Abstract
- Background: In the acute respiratory distress syndrome (ARDS), lung-protective ventilation strategies combine the delivery of small tidal volumes (VT) with sufficient positive end-expiratory pressure (PEEP). However, an optimal approach guiding the setting of PEEP has not been defined. Monitoring volumetric capnography is useful to detect changes in lung aeration. Objectives: The aim of this study was to determine whether volumetric capnography may be a useful method to determine the optimal PEEP in ARDS. Methods: In 8 lung-lavaged piglets, PEEP was reduced from 20 to 4 cm H2O in steps of 4 cm H2O every 10 min followed by full lung recruitment. Volumetric capnography, respiratory mechanics, blood gas analysis, hemodynamic data and whole-lung computed tomography scans were obtained at each PEEP level. Results: After lung recruitment, end-expiratory lung volume progressively decreased from 1,160 ± 273 ml at PEEP 20 cm H2O to 314 ± 86 ml at PEEP 4 cm H2O. The ratio of alveolar dead space (VDalv) to alveolar VT (VTalv) and the phase III slope of volumetric capnography (SIII) reached a minimum at PEEP 16 cm H2O. At this PEEP level, overaerated lung regions were significantly reduced, nonaerated lung regions did not increase, and partial pressure of oxygen in arterial blood/fraction of inspired oxygen (P/F) and static respiratory system compliance (Crs) reached a maximum. At PEEP levels <16 cm H2O, nonaerated lung regions significantly increased, P/F and Crs deteriorated, and VDalv/VTalv and SIII began to increase. Conclusions: In this surfactant-depleted model, PEEP at the lowest VDalv/VTalv and SIII allows an optimal balance between lung overinflation and collapse. Hence, volumetric capnography is a useful bedside approach to identify the optimal PEEP. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]
- Subjects :
- *ADULT respiratory distress syndrome treatment
*LUNG injury prevention
*ACUTE diseases
*ANALYSIS of variance
*ANIMAL experimentation
*BLOOD gases analysis
*CAPNOGRAPHY
*STATISTICAL correlation
*HEMODYNAMICS
*REGRESSION analysis
*RESEARCH funding
*SWINE
*TOMOGRAPHY
*DATA analysis software
*RESPIRATORY mechanics
*DESCRIPTIVE statistics
*POSITIVE end-expiratory pressure
*PREVENTION
Subjects
Details
- Language :
- English
- ISSN :
- 00257931
- Volume :
- 87
- Issue :
- 1
- Database :
- Academic Search Index
- Journal :
- Respiration
- Publication Type :
- Academic Journal
- Accession number :
- 94232392
- Full Text :
- https://doi.org/10.1159/000354787