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Selecting the 'right' positive end-expiratory pressure level
- Source :
- Current opinion in critical care. 21(1)
- Publication Year :
- 2014
-
Abstract
- To compare the positive end-expiratory pressure selection aiming either to oxygenation or to the full lung opening.Increasing positive end-expiratory pressure in patients with severe hypoxemia is associated with better outcome if the oxygenation response is greater and positive end-expiratory pressure tests may be performed in a few minutes. The oxygenation response to recruitment maneuvers was associated with better outcome in patients with acute respiratory distress syndrome from influenza A (H1N1). If, after recruitment maneuver, the recruitment is not sustained by sufficient positive end-expiratory pressure, the lung will unavoidably collapse. Several papers investigated the positive end-expiratory pressure selection according to the deflation limb of the pressure-volume curve. It is still questionable whether to consider oxygenation or respiratory mechanics change as the best marker for adequate selection. A growing interest is paid to the estimate of transpulmonary pressure, although no consensus is available on which methodology is preferable. Finally, the positive end-expiratory pressure adequate for full lung opening may be computed combining the computed tomography scan variables and the chest wall elastance.When compared, most of the methods give the same positive end-expiratory pressure values in patients with higher and lower recruitability. The positive end-expiratory pressure/inspiratory oxygen fraction tables are the only methods providing lower positive end-expiratory pressure in lower recruiters and higher positive end-expiratory pressure in higher recruiters.
- Subjects :
- Respiratory physiology
Critical Care and Intensive Care Medicine
Positive-Pressure Respiration, Intrinsic
Positive-Pressure Respiration
Influenza A Virus, H1N1 Subtype
Severe hypoxemia
mental disorders
Influenza, Human
Tidal Volume
Medicine
Animals
Humans
In patient
Tidal volume
Positive end-expiratory pressure
Respiratory Distress Syndrome
Lung
business.industry
Lung volume measurement
Oxygenation
respiratory tract diseases
medicine.anatomical_structure
Anesthesia
Respiratory Mechanics
business
Lung Volume Measurements
Tomography, X-Ray Computed
Subjects
Details
- ISSN :
- 15317072
- Volume :
- 21
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Current opinion in critical care
- Accession number :
- edsair.doi.dedup.....f1b58775b2087dabf32665c0200ebd4d