BACKGROUND: The most appropriate method of determining positive end-expiratory pressure (PEEP) level during a lung protective ventilatory strategy has not been established. METHODS: In a lavage-injured sheep acute respiratory distress syndrome model, the authors compared the effects of three approaches to determining PEEP level after a recruitment maneuver: (1) 2 cm H(2)O above the lower inflection point on the inflation pressure-volume curve, (2) at the point of maximum curvature on the deflation pressure-volume curve, and (3) at the PEEP level that maintained target arterial oxygen partial pressure at a fraction of inspired oxygen of 0.5. RESULTS: Positive end-expiratory pressure set 2 cm H(2)O above the lower inflection point resulted in the least injury over the course of the study. PEEP based on adequate arterial oxygen partial pressure/fraction of inspired oxygen ratios had to be increased over time and resulted in higher mRNA levels for interleukin-8 and interleukin-1beta and greater tissue inflammation when compared with the other approaches. PEEP at the point of maximum curvature could not maintain eucapneia even at an increased ventilatory rate. CONCLUSION: Although generating higher plateau pressures, PEEP levels based on pressure-volume curve analysis were more effective in maintaining gas exchange and minimizing injury than PEEP based on adequate oxygenation. PEEP at 2 cm H(2)O above the lower inflection point was most effective.
BACKGROUND: The most appropriate method of determining positive end-expiratory pressure (PEEP) level during a lung protective ventilatory strategy has not been established. METHODS: In a lavage-injured sheep acute respiratory distress syndrome model, the authors compared the effects of three approaches to determining PEEP level after a recruitment maneuver: (1) 2 cm H(2)O above the lower inflection point on the inflation pressure-volume curve, (2) at the point of maximum curvature on the deflation pressure-volume curve, and (3) at the PEEP level that maintained target arterial oxygen partial pressure at a fraction of inspired oxygen of 0.5. RESULTS: Positive end-expiratory pressure set 2 cm H(2)O above the lower inflection point resulted in the least injury over the course of the study. PEEP based on adequate arterial oxygen partial pressure/fraction of inspired oxygen ratios had to be increased over time and resulted in higher mRNA levels for interleukin-8 and interleukin-1beta and greater tissue inflammation when compared with the other approaches. PEEP at the point of maximum curvature could not maintain eucapneia even at an increased ventilatory rate. CONCLUSION: Although generating higher plateau pressures, PEEP levels based on pressure-volume curve analysis were more effective in maintaining gas exchange and minimizing injury than PEEP based on adequate oxygenation. PEEP at 2 cm H(2)O above the lower inflection point was most effective.
Authors: Raffaele L Dellacà; Emanuela Zannin; Peter Kostic; Marie Andersson Olerud; Pasquale P Pompilio; Goran Hedenstierna; Antonio Pedotti; Peter Frykholm Journal: Intensive Care Med Date: 2011-04-01 Impact factor: 17.440
Authors: Guillermo M Albaiceta; Luis H Luyando; Diego Parra; Rafael Menendez; Juan Calvo; Paula Rodríguez Pedreira; Francisco Taboada Journal: Intensive Care Med Date: 2005-08-10 Impact factor: 17.440
Authors: Maina M B Morales; Ruy C Pires-Neto; Nicole Inforsato; Tatiana Lanças; Luiz F F da Silva; Paulo H N Saldiva; Thais Mauad; Carlos R R Carvalho; Marcelo B P Amato; Marisa Dolhnikoff Journal: Crit Care Date: 2011-01-06 Impact factor: 9.097
Authors: Alysson Roncally S Carvalho; Frederico C Jandre; Alexandre V Pino; Fernando A Bozza; Jorge Salluh; Rosana Rodrigues; Fabio O Ascoli; Antonio Giannella-Neto Journal: Crit Care Date: 2007 Impact factor: 9.097