OBJECTIVE: To test the usefulness of dead space for determining open-lung PEEP, the lowest PEEP that prevents lung collapse after a lung recruitment maneuver. DESIGN: Prospective animal study. SETTING: Department of Clinical Physiology, University of Uppsala, Sweden. SUBJECTS: Eight lung-lavaged pigs. INTERVENTIONS: Animals were ventilated using constant flow mode with VT of 6ml/kg, respiratory rate of 30bpm, inspiratory-to-expiratory ratio of 1:2, and FiO(2) of 1. Baseline measurements were performed at 6cmH(2)O of PEEP. PEEP was increased in steps of 6cmH(2)O from 6 to 24cmH(2)O. Recruitment maneuver was achieved within 2min at pressure levels of 60/30cmH(2)O for Peak/PEEP. PEEP was decreased from 24 to 6cmH(2)O in steps of 2cmH(2)O and then to 0cmH(2)O. Each PEEP step was maintained for 10min. MEASUREMENTS AND RESULTS: Alveolar dead space (VD(alv)), the ratio of alveolar dead space to alveolar tidal volume (VD(alv)/VT(alv)), and the arterial to end-tidal PCO(2) difference (Pa-ET: CO(2)) showed a good correlation with PaO(2), normally aerated areas, and non-aerated CT areas in all animals (minimum-maximum r(2)=0.83-0.99; p<0.01). Lung collapse (non-aerated tissue>5%) started at 12[Symbol: see text]cmH(2)O PEEP; hence, open-lung PEEP was established at 14cmH(2)O. The receiver operating characteristics curve demonstrated a high specificity and sensitivity of VD(alv) (0.89 and 0.90), VD(alv)/VT(alv) (0.82 and 1.00), and Pa-ET: CO(2) (0.93 and 0.95) for detecting lung collapse. CONCLUSIONS: Monitoring of dead space was useful for detecting lung collapse and for establishing open-lung PEEP after a recruitment maneuver.
OBJECTIVE: To test the usefulness of dead space for determining open-lung PEEP, the lowest PEEP that prevents lung collapse after a lung recruitment maneuver. DESIGN: Prospective animal study. SETTING: Department of Clinical Physiology, University of Uppsala, Sweden. SUBJECTS: Eight lung-lavaged pigs. INTERVENTIONS: Animals were ventilated using constant flow mode with VT of 6ml/kg, respiratory rate of 30bpm, inspiratory-to-expiratory ratio of 1:2, and FiO(2) of 1. Baseline measurements were performed at 6cmH(2)O of PEEP. PEEP was increased in steps of 6cmH(2)O from 6 to 24cmH(2)O. Recruitment maneuver was achieved within 2min at pressure levels of 60/30cmH(2)O for Peak/PEEP. PEEP was decreased from 24 to 6cmH(2)O in steps of 2cmH(2)O and then to 0cmH(2)O. Each PEEP step was maintained for 10min. MEASUREMENTS AND RESULTS: Alveolar dead space (VD(alv)), the ratio of alveolar dead space to alveolar tidal volume (VD(alv)/VT(alv)), and the arterial to end-tidal PCO(2) difference (Pa-ET: CO(2)) showed a good correlation with PaO(2), normally aerated areas, and non-aerated CT areas in all animals (minimum-maximum r(2)=0.83-0.99; p<0.01). Lung collapse (non-aerated tissue>5%) started at 12[Symbol: see text]cmH(2)O PEEP; hence, open-lung PEEP was established at 14cmH(2)O. The receiver operating characteristics curve demonstrated a high specificity and sensitivity of VD(alv) (0.89 and 0.90), VD(alv)/VT(alv) (0.82 and 1.00), and Pa-ET: CO(2) (0.93 and 0.95) for detecting lung collapse. CONCLUSIONS: Monitoring of dead space was useful for detecting lung collapse and for establishing open-lung PEEP after a recruitment maneuver.
Authors: Hajo Reissmann; Stephan H Böhm; Fernando Suárez-Sipmann; Gerardo Tusman; Claas Buschmann; Stefan Maisch; Tanja Pesch; Oliver Thamm; Christoph Plümers; Jochen Schulte am Esch; Göran Hedenstierna Journal: Intensive Care Med Date: 2005-02-03 Impact factor: 17.440
Authors: G R Bernard; A Artigas; K L Brigham; J Carlet; K Falke; L Hudson; M Lamy; J R Legall; A Morris; R Spragg Journal: Am J Respir Crit Care Med Date: 1994-03 Impact factor: 21.405
Authors: M B Amato; C S Barbas; D M Medeiros; R B Magaldi; G P Schettino; G Lorenzi-Filho; R A Kairalla; D Deheinzelin; C Munoz; R Oliveira; T Y Takagaki; C R Carvalho Journal: N Engl J Med Date: 1998-02-05 Impact factor: 91.245
Authors: T E Kloot; L Blanch; A Melynne Youngblood; C Weinert; A B Adams; J J Marini; R S Shapiro; A Nahum Journal: Am J Respir Crit Care Med Date: 2000-05 Impact factor: 21.405
Authors: V M Ranieri; H Zhang; L Mascia; M Aubin; C Y Lin; J B Mullen; S Grasso; M Binnie; G A Volgyesi; P Eng; A S Slutsky Journal: Anesthesiology Date: 2000-11 Impact factor: 7.892
Authors: Peter Andrews; Elie Azoulay; Massimo Antonelli; Laurent Brochard; Christian Brun-Buisson; Daniel De Backer; Geoffrey Dobb; Jean-Yves Fagon; Herwig Gerlach; Johan Groeneveld; Duncan Macrae; Jordi Mancebo; Philipp Metnitz; Stefano Nava; Jerôme Pugin; Michael Pinsky; Peter Radermacher; Christian Richard Journal: Intensive Care Med Date: 2006-12-19 Impact factor: 17.440
Authors: Jorn Fierstra; Matthew Machina; Anne Battisti-Charbonney; James Duffin; Joseph Arnold Fisher; Leonid Minkovich Journal: Intensive Care Med Date: 2011-06-07 Impact factor: 17.440
Authors: Jeremy R Beitler; B Taylor Thompson; Michael A Matthay; Daniel Talmor; Kathleen D Liu; Hanjing Zhuo; Douglas Hayden; Roger G Spragg; Atul Malhotra Journal: Crit Care Med Date: 2015-05 Impact factor: 7.598
Authors: Andreas W Reske; Harald Busse; Marcelo B P Amato; Matthias Jaekel; Thomas Kahn; Peter Schwarzkopf; Dierk Schreiter; Udo Gottschaldt; Matthias Seiwerts Journal: Intensive Care Med Date: 2008-06-08 Impact factor: 17.440
Authors: Jorn Fierstra; Jeff D Winter; Matthew Machina; Jelena Lukovic; James Duffin; Andrea Kassner; Joseph A Fisher Journal: J Clin Monit Comput Date: 2012-10-26 Impact factor: 2.502