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Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome
- Publication Year :
- 2008
-
Abstract
- Lung injury caused by a ventilator results from nonphysiologic lung stress (transpulmonary pressure) and strain (inflated volume to functional residual capacity ratio).To determine whether plateau pressure and tidal volume are adequate surrogates for stress and strain, and to quantify the stress to strain relationship in patients and control subjects.Nineteen postsurgical healthy patients (group 1), 11 patients with medical diseases (group 2), 26 patients with acute lung injury (group 3), and 24 patients with acute respiratory distress syndrome (group 4) underwent a positive end-expiratory pressure (PEEP) trial (5 and 15 cm H2O) with 6, 8, 10, and 12 ml/kg tidal volume.Plateau airway pressure, lung and chest wall elastances, and lung stress and strain significantly increased from groups 1 to 4 and with increasing PEEP and tidal volume. Within each group, a given applied airway pressure produced largely variable stress due to the variability of the lung elastance to respiratory system elastance ratio (range, 0.33-0.95). Analogously, for the same applied tidal volume, the strain variability within subgroups was remarkable, due to the functional residual capacity variability. Therefore, low or high tidal volume, such as 6 and 12 ml/kg, respectively, could produce similar stress and strain in a remarkable fraction of patients in each subgroup. In contrast, the stress to strain ratio-that is, specific lung elastance-was similar throughout the subgroups (13.4 +/- 3.4, 12.6 +/- 3.0, 14.4 +/- 3.6, and 13.5 +/- 4.1 cm H2O for groups 1 through 4, respectively; P = 0.58) and did not change with PEEP and tidal volume.Plateau pressure and tidal volume are inadequate surrogates for lung stress and strain. Clinical trial registered with www.clinicaltrials.gov (NCT 00143468).
- Subjects :
- Pulmonary and Respiratory Medicine
Adult
Male
Critical Care
Functional Residual Capacity
medicine.medical_treatment
Acute lung injury
Acute respiratory distress syndrome
Strain
Stress
mechanical
Ventilator-induced lung injury
Pulmonary compliance
Lung injury
Critical Care and Intensive Care Medicine
Positive-Pressure Respiration
Plateau pressure
Functional residual capacity
Postoperative Complications
Reference Values
medicine
Tidal Volume
Humans
Thoracic Wall
Lung Compliance
Mathematical Computing
Tidal volume
Aged
Mechanical ventilation
Respiratory Distress Syndrome
Respiratory distress
business.industry
Airway Resistance
respiratory system
Middle Aged
respiratory tract diseases
Biomechanical Phenomena
Anesthesia
Respiratory Mechanics
Female
business
Pulmonary Ventilation
Transpulmonary pressure
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....5f7c85d2a26e2715292ece2ec38c8b98