101
|
Ait-Oufella H, Tharaux PL, Baudel JL, Vandermeersch S, Meyer P, Tonnellier M, Dussaule JC, Guidet B, Offenstadt G, Maury E. Variation in natriuretic peptides and mitral flow indexes during successful ventilatory weaning: a preliminary study. Intensive Care Med 2007; 33:1183-1186. [PMID: 17404702 DOI: 10.1007/s00134-007-0627-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 03/12/2007] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess the cardiac consequences of successful respiratory weaning using the variations of circulating B-type and atrial natriuretic peptides (BNP, ANP) and Doppler mitral flow. DESIGN A prospective preliminary observational study. SETTING A 14-bed medical ICU in a French university hospital. PATIENTS Thirty-one patients undergoing a spontaneous breathing trial on a T-tube. INTERVENTIONS Circulating BNP and ANP levels and Doppler-derived E/A ratio and deceleration time of the E wave were measured before and 1 h after disconnection. RESULTS BNP levels increased from 299 pg/ml (range 56-1079) to 412 pg/ml (147-1324) (p=0.02) in patients with systolic left ventricular dysfunction, decreased from 98 pg/ml (25-337) to 45 pg/ml (38-180) (p=0.04) in patients with right ventricular dilation and remained unchanged in patients with neither of these cardiac abnormalities. Overall ANP levels increased from 33 pg/ml to 67 pg/ml (p<0.001) regardless of ventricular function. The E/A ratio increased from 0.91 (0.66-3.56) to 1.17 (0.5-4.76), (p=0.01), after disconnection, whereas deceleration time of E wave decreased from 185 ms (120-280) to 160 ms (70-206) (p=0.02). CONCLUSION During successful weaning from mechanical ventilation ANP levels increase in all patients whereas changes in BNP levels depend on underlying cardiac function. Changes in Doppler mitral flow indexes following ventilator disconnection suggest an increase in left-ventricular filling pressure.
Collapse
Affiliation(s)
- Hafid Ait-Oufella
- Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France
| | | | - Jean-Luc Baudel
- Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France
| | | | - Pascal Meyer
- Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France
| | - Marc Tonnellier
- Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France
| | | | - Bertrand Guidet
- Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France
- Université Pierre et Marie Curie-Paris 6, UMR S 707, 75012, Paris, France
| | - Georges Offenstadt
- Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France
- Université Pierre et Marie Curie-Paris 6, UMR S 707, 75012, Paris, France
| | - Eric Maury
- Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France.
- Université Pierre et Marie Curie-Paris 6, UMR S 707, 75012, Paris, France.
| |
Collapse
|
102
|
Miranda DR, Gommers D, Papadakos PJ, Lachmann B. Mechanical Ventilation Affects Pulmonary Inflammation in Cardiac Surgery Patients: The Role of the Open-Lung Concept. J Cardiothorac Vasc Anesth 2007; 21:279-84. [PMID: 17418750 DOI: 10.1053/j.jvca.2006.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Indexed: 11/11/2022]
|
103
|
Abdulhay E, Baconnier P. Stroke volume estimation by thoracocardiography is better when glottis is closed. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2007; 2007:1074-1077. [PMID: 18002147 DOI: 10.1109/iembs.2007.4352481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Thoracocardiography approach pretends to non-invasively monitor stroke volume by inductive plethysmographic recording of ventricular volume curves by a transducer placed on the chest. The purpose of this study was to investigate the potential of thoracocardiography to estimate stroke volumes while apnea with open glottis. We hypothesized that, when glottis is open, stroke volumes would be better estimated if airways flow curves were taken into account.
Collapse
Affiliation(s)
- Enas Abdulhay
- PRETA Team (Physiologie Respiratoire Expérimentale Théorique et Appliquée), TIMC, Faculté de Médecine, 38706 La Tronche cedex, France.
| | | |
Collapse
|
104
|
Kim GB, Noh CI. Intensive management of acute right heart failure. KOREAN JOURNAL OF PEDIATRICS 2007. [DOI: 10.3345/kjp.2007.50.11.1041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Gi Beom Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Chung Il Noh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
105
|
Frazier SK, Stone KS, Moser D, Schlanger R, Carle C, Pender L, Widener J, Brom H. Hemodynamic Changes During Discontinuation of Mechanical Ventilation in Medical Intensive Care Unit Patients. Am J Crit Care 2006. [DOI: 10.4037/ajcc2006.15.6.580] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
• Background Cardiac dysfunction can prevent successful discontinuation of mechanical ventilation. Critically ill patients may have undetected cardiac disease, and cardiac dysfunction can be produced or exacerbated by underlying pathophysiology.
• Objective To describe and compare hemodynamic function and cardiac rhythm during baseline mechanical ventilation with function and rhythm during a trial of continuous positive airway pressure in medical intensive care patients.
• Methods A convenience sample of 43 patients (53% men; mean age 51.1 years) who required mechanical ventilation were recruited for this pilot study. Cardiac output, stroke volume, arterial blood pressure, heart rate, cardiac rhythm, and plasma catecholamine levels were measured during mechanical ventilation and during a trial of continuous positive airway pressure.
• Results One third of the patients had difficulty discontinuing mechanical ventilation. Successful patients had significantly increased cardiac output and stroke volume without changes in heart rate or arterial pressure during the trial of continuous positive airway pressure. Unsuccessful patients had no significant changes in cardiac output, stroke volume, or heart rate but had a significant increase in mean arterial pressure. The 2 groups of patients also had different patterns in ectopy. Concurrently, catecholamine concentrations decreased in the successful patients and significantly increased in the unsuccessful patients during the trial.
• Conclusions Patterns of cardiac function and plasma catecholamine levels differed between patients who did or did not achieve spontaneous ventilation with a trial of continuous positive airway pressure. Cardiac function must be systematically considered before and during the return to spontaneous ventilation to optimize the likelihood of success.
Collapse
Affiliation(s)
- Susan K. Frazier
- University of Kentucky College of Nursing, Lexington, Ky (skf, dm) and Ohio State University College of Nursing, Columbus, Ohio (kss, rs, cc, lp, jw, hb)
| | - Kathleen S. Stone
- University of Kentucky College of Nursing, Lexington, Ky (skf, dm) and Ohio State University College of Nursing, Columbus, Ohio (kss, rs, cc, lp, jw, hb)
| | - Debra Moser
- University of Kentucky College of Nursing, Lexington, Ky (skf, dm) and Ohio State University College of Nursing, Columbus, Ohio (kss, rs, cc, lp, jw, hb)
| | - Rebecca Schlanger
- University of Kentucky College of Nursing, Lexington, Ky (skf, dm) and Ohio State University College of Nursing, Columbus, Ohio (kss, rs, cc, lp, jw, hb)
| | - Carolyn Carle
- University of Kentucky College of Nursing, Lexington, Ky (skf, dm) and Ohio State University College of Nursing, Columbus, Ohio (kss, rs, cc, lp, jw, hb)
| | - Lauren Pender
- University of Kentucky College of Nursing, Lexington, Ky (skf, dm) and Ohio State University College of Nursing, Columbus, Ohio (kss, rs, cc, lp, jw, hb)
| | - Jeanne Widener
- University of Kentucky College of Nursing, Lexington, Ky (skf, dm) and Ohio State University College of Nursing, Columbus, Ohio (kss, rs, cc, lp, jw, hb)
| | - Heather Brom
- University of Kentucky College of Nursing, Lexington, Ky (skf, dm) and Ohio State University College of Nursing, Columbus, Ohio (kss, rs, cc, lp, jw, hb)
| |
Collapse
|
106
|
Vieillard-Baron A, Charron C, Chergui K, Peyrouset O, Jardin F. Bedside echocardiographic evaluation of hemodynamics in sepsis: is a qualitative evaluation sufficient? Intensive Care Med 2006; 32:1547-52. [PMID: 16855828 DOI: 10.1007/s00134-006-0274-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 06/09/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Transesophageal echocardiography (TEE) has proven its efficiency in assessing hemodynamics in patients by its ability to evaluate cardiac function and fluid responsiveness. Classically, it requires quantitative measurements, whereas in routine practice TEE is used in our unit especially as a qualitative procedure. We assessed the accuracy of this qualitative central hemodynamic evaluation obtained by TEE at the bedside. DESIGN AND SETTING Prospective study conducted in a medical ICU between September 2004 and April 2005. All TEE examinations performed in consecutive patients hospitalized for septic shock and mechanically ventilated for an associated acute lung injury were eligible for evaluation. Intensivists trained in echocardiography were asked to classify (a) respiratory changes in the superior vena cava (SVC), (b) left ventricular (LV) systolic function, (c) right ventricular (RV) end-diastolic size, and (d) shape and kinetics of the interventricular septum (IVS). A post-hoc quantitative evaluation was then performed by a trained investigator unaware of the patients' status. RESULTS We evaluated 83 examinations in 30 patients. Qualitative evaluation was easily able to distinguish patients with significant or nonsignificant SVC respiratory changes, normal, moderately or markedly depressed LV systolic function, and nondilated or dilated right ventricle. Acute cor pulmonale was also well recognized. CONCLUSION By its ability accurately to evaluate hemodynamic status qualitative TEE could be useful for intensivists in managing circulatory failure in septic shock, rendering the more time-consuming quantitative evaluation useless.
Collapse
Affiliation(s)
- Antoine Vieillard-Baron
- University Hospital Ambroise Paré, Assistance Publique Hôpitaux de Paris, Medical Intensive Care Unit, 9 avenue Charles de Gaulle, 92104 Boulogne Cedex, France.
| | | | | | | | | |
Collapse
|
107
|
Michaux I, Filipovic M, Skarvan K, Schneiter S, Seeberger MD. Accuracy of tissue Doppler estimation of the right atrial pressure in anesthetized, paralyzed, and mechanically ventilated patients. Am J Cardiol 2006; 97:1654-6. [PMID: 16728232 DOI: 10.1016/j.amjcard.2005.12.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Revised: 12/19/2005] [Accepted: 12/19/2005] [Indexed: 01/23/2023]
Abstract
The ratio of tricuspid peak early inflow velocity to peak early diastolic velocity of the lateral tricuspid annulus (the E/Ea ratio) measured by transthoracic echocardiography has been reported to correlate with right atrial (RA) pressure. In this study, the correlation between the E/Ea ratio and RA pressure was tested in 44 anesthetized, paralyzed, and mechanically ventilated patients by transesophageal echocardiography. Mean RA pressure and the following echocardiographic data were recorded simultaneously: tricuspid peak early inflow velocities by Doppler echocardiography, peak early diastolic velocity of the lateral tricuspid annulus by tissue Doppler imaging, and right ventricular and left ventricular end-diastolic areas. Linear regression did not indicate a correlation between the E/Ea ratio and RA pressure (r = -0.11, p = 0.48) or between the E/Ea ratio and the right or left ventricular end-diastolic area index; it revealed a weak correlation between RA pressure and the inspiratory plateau pressure and body mass index. In conclusion, the E/Ea ratio failed to predict RA pressure or planimetric indexes of ventricular preload in anesthetized, paralyzed, and mechanically ventilated patients. In these patients, RA pressure was largely influenced by extracardiac factors.
Collapse
Affiliation(s)
- Isabelle Michaux
- Department of Anaesthesia, Division of Cardiology, University Hospital of Basel, Basel, Switzerland.
| | | | | | | | | |
Collapse
|
108
|
Nielsen J, Nilsson M, Fredén F, Hultman J, Alström U, Kjaergaard J, Hedenstierna G, Larsson A. Central hemodynamics during lung recruitment maneuvers at hypovolemia, normovolemia and hypervolemia. A study by echocardiography and continuous pulmonary artery flow measurements in lung-injured pigs. Intensive Care Med 2006; 32:585-94. [PMID: 16520996 DOI: 10.1007/s00134-006-0082-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Accepted: 01/18/2006] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The impact of lung-recruitment maneuvers on heart function at different volemic levels has not been studied in detail. We therefore investigated the effect on central hemodynamics of lung recruitment maneuvers at hypovolemia, normovolemia and hypervolemia in experimental lung injury. DESIGN Randomized, controlled, cross-over experimental study. SETTING Animal laboratory at a university hospital. PARTICIPANTS Eleven anesthetized and lung-lavaged pigs. INTERVENTION The animals were randomized to 10-s lung recruitment maneuvers followed by 30-s maneuvers (40 cm H(2)O airway pressure) or vice versa, performed under hypovolemia, normovolemia and hypervolemia. MEASUREMENTS AND MAIN RESULTS Left-ventricular end-diastolic diameter and cardiac output were measured before, during, and 1 min and 5 min after the lung recruitment maneuver and left-ventricular eccentricity index was calculated for before and during the maneuver. Cardiac output and left-ventricular end-diastolic diameter (within parentheses) decreased significantly during both the 10-s and 30-s lung recruitment maneuvers at hypovolemia, by a mean of 89% (35) and 92% (33), at normovolemia by 75% (33) and 86% (32), and at hypervolemia by 56% (32) and 64% (43), respectively. At hypovolemia, cardiac output was increased above baseline 1-5 min following the 30-s maneuver. Left-ventricular eccentricity index increased significantly during the maneuver, indicating right ventricular dysfunction. CONCLUSIONS In this animal lung injury model, lung recruitment maneuvers significantly decreased left-ventricular end-diastolic volume and cardiac output at hypovolemia. Hypervolemia did partly counteract this compromise. In addition, a marked right-ventricular dysfunction during the maneuver was found.
Collapse
Affiliation(s)
- Jonas Nielsen
- Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital, Gentofte, Niels Andersensvej 65, 2900 Hellerup, Denmark.
| | | | | | | | | | | | | | | |
Collapse
|
109
|
Piazza G, Goldhaber SZ. The acutely decompensated right ventricle: pathways for diagnosis and management. Chest 2005; 128:1836-52. [PMID: 16162794 DOI: 10.1378/chest.128.3.1836] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Decompensated right ventricular (RV) failure is becoming increasingly common as the prevalence of predisposing conditions grows. Advances in diagnosis and management have granted insights into the following pathophysiologic mechanisms of RV dysfunction: impaired RV contractility, RV pressure overload, and RV volume overload. Emerging imaging modalities, such as cardiac MRI, and new therapeutic agents, such as pulmonary selective vasodilators, have expanded our options for evaluation and management, respectively. An improved understanding of pathophysiology and technologic progress provides us with new pathways in the diagnosis and hemodynamic support of these often critically ill patients.
Collapse
Affiliation(s)
- Gregory Piazza
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | |
Collapse
|
110
|
Luecke T, Pelosi P. Clinical review: Positive end-expiratory pressure and cardiac output. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2005; 9:607-21. [PMID: 16356246 PMCID: PMC1414045 DOI: 10.1186/cc3877] [Citation(s) in RCA: 247] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In patients with acute lung injury, high levels of positive end-expiratory pressure (PEEP) may be necessary to maintain or restore oxygenation, despite the fact that 'aggressive' mechanical ventilation can markedly affect cardiac function in a complex and often unpredictable fashion. As heart rate usually does not change with PEEP, the entire fall in cardiac output is a consequence of a reduction in left ventricular stroke volume (SV). PEEP-induced changes in cardiac output are analyzed, therefore, in terms of changes in SV and its determinants (preload, afterload, contractility and ventricular compliance). Mechanical ventilation with PEEP, like any other active or passive ventilatory maneuver, primarily affects cardiac function by changing lung volume and intrathoracic pressure. In order to describe the direct cardiocirculatory consequences of respiratory failure necessitating mechanical ventilation and PEEP, this review will focus on the effects of changes in lung volume, factors controlling venous return, the diastolic interactions between the ventricles and the effects of intrathoracic pressure on cardiac function, specifically left ventricular function. Finally, the hemodynamic consequences of PEEP in patients with heart failure, chronic obstructive pulmonary disease and acute respiratory distress syndrome are discussed.
Collapse
Affiliation(s)
- Thomas Luecke
- Section Head, Critical Care, Department of Anesthesiology and Critical Care Medicine, University Hospital of Mannheim, Germany
| | - Paolo Pelosi
- Associate Professor in Anaesthesia and Intensive Care, Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi dell'Insubria, Varese, Italy
| |
Collapse
|
111
|
Michard F, Schachtrupp A, Toens C. Factors influencing the estimation of extravascular lung water by transpulmonary thermodilution in critically ill patients*. Crit Care Med 2005; 33:1243-7. [PMID: 15942338 DOI: 10.1097/01.ccm.0000164566.23147.35] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate factors that may influence the estimation of extravascular lung water (EVLW) with a single (cold) indicator compared with assessment using two indicators (thermo-dye dilution). DESIGN Post hoc analysis of an electronic hemodynamic database. SETTING Surgical intensive care unit of a university hospital. PATIENTS Forty-eight critically ill patients monitored by the thermo-dye dilution technique in the postoperative period. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The EVLW was simultaneously assessed by the thermo-dye dilution technique (EVLWref) and estimated by transpulmonary thermodilution (EVLWest). EVLWref index ranged between 1 and 40 mL/kg (mean 10 +/- 7 mL/kg) and EVLWest between 2 and 39 mL/kg (mean 9 +/- 6 mL/kg). EVLWref was closely correlated (r = .96) with EVLWest. The mean difference (bias) between EVLWref and EVLWest was -0.5 +/- 1.9 mL/kg. The bias was not influenced by the weight, height, body surface area, body mass index, Pao2, intrathoracic blood volume, cardiac output, or dosage of vasoactive agents. In contrast, the bias was slightly but significantly influenced by EVLWref, Pao2/Fio2 ratio, tidal volume, and level of positive end-expiratory pressure. CONCLUSIONS In our surgical intensive care unit population, the estimation of EVLW by transpulmonary thermodilution was influenced by the amount of EVLW, the Pao2/Fio2 ratio, the tidal volume, and the level of positive end-expiratory pressure. However, compared with the double indicator method, transpulmonary thermodilution estimation remained clinically acceptable even in patients with severe lung disease.
Collapse
Affiliation(s)
- Frédéric Michard
- Department of Anesthesia and Critical Care, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA.
| | | | | |
Collapse
|
112
|
Hofmann D, Klein M, Wegscheider K, Sakka SG. Erweitertes h�modynamisches Monitoring mithilfe der transpulmonalen Thermodilution. Anaesthesist 2005; 54:319-26. [PMID: 15726244 DOI: 10.1007/s00101-005-0809-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The transpulmonary thermal-dye dilution (TDD) is the clinical gold standard for measurement of intrathoracic blood volume (ITBV) and extravascular lung water (EVLW). Recently, experimental and clinical studies found that ITBV and EVLW can be derived reliably by single transpulmonary thermodilution (TD), however, dependency from various factors of lung function has been discussed. PATIENTS AND METHODS We retrospectively analyzed data from 174 critically ill patients who had undergone hemodynamic monitoring by TDD. We calculated the differences of simultaneous TD and TDD determined by ITBV or EVLW measurements. Bias and standard deviations (SD) were calculated and extended Bland-Altman regression analyses were performed. Association of the differences and the potential confounders gender, age, PEEP, p(a)O(2)/F(I)O(2) ratio and the corresponding TDD measurement were analyzed by multiple linear regression and LOWESS regression. RESULTS Overall results (bias+/-SD) were 1+/-58 ml/m(2) for ITBV and 0.0+/-1.4 ml/kg bw for EVLW, but TD overestimated TDD results in patients with higher ITBV and underestimated those for lower ITBV values. The deviations were small, and the dependence of ITBV could be explained completely by dependence on PEEP and age. However, low values of EVLW are overestimated by TD. CONCLUSION Single transpulmonary thermodilution for estimation of ITBV or EVLW is reliable in patients with severe lung injury for normal and higher values.
Collapse
Affiliation(s)
- D Hofmann
- Klinik für Anästhesiologie und Intensivtherapie, Friedrich-Schiller-Universität, Jena
| | | | | | | |
Collapse
|
113
|
Grasso S, Fanelli V, Cafarelli A, Anaclerio R, Amabile M, Ancona G, Fiore T. Effects of high versus low positive end-expiratory pressures in acute respiratory distress syndrome. Am J Respir Crit Care Med 2005; 171:1002-8. [PMID: 15665322 DOI: 10.1164/rccm.200407-940oc] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A recent study by the Acute Respiratory Distress Syndrome Network compared the traditional lower end-expiratory pressure strategy with a higher end-expiratory pressure strategy in patients with the acute respiratory distress syndrome ventilated with low tidal volumes. Clinical outcomes were similar whether lower or higher positive end-expiratory pressure (PEEP) levels were used. We applied both the lower (9 +/- 2 cm H2O) and higher (16 +/- 1 cm H2O) PEEP strategy in 19 patients. In nine recruiters, the higher end-expiratory pressure strategy resulted in significant alveolar recruitment (587 +/- 158 ml), improvement in arterial oxygen partial pressure/inspired oxygen fraction ratio (from 150 +/- 36 to 396 +/- 138), and reduction in static lung elastance (from 23 +/- 3 to 20 +/- 2 cm H2O/L). In 10 nonrecruiters, alveolar recruitment was minimal, oxygenation did not improve, and static lung elastance significantly increased (from 26 +/- 5 to 28 +/- 6 cm H2O/L). The increase in oxygenation, the reduction in static lung elastance, and the shape of the volume-pressure curve during the lower PEEP strategy were independently associated with alveolar recruitment. In conclusion, the protocol proposed by the Acute Respiratory Distress Syndrome Network, lacking solid physiologic basis, frequently fails to induce alveolar recruitment and may increase the risk of alveolar overinflation.
Collapse
Affiliation(s)
- Salvatore Grasso
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Ospedale Policlinico, Piazza Giulio Cesare 11, Bari, Italy 70124.
| | | | | | | | | | | | | |
Collapse
|