Davide Chiumello1, Sara Froio2, Giovanni Mistraletti3, Paolo Formenti2, Luca Bolgiaghi2, Antonio Cammaroto4, Michele Umbrello2, Silvia Coppola2. 1. SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy; Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy; Centro ricerca coordinata di insufficienza respiratoria, Università degli Studi di Milano, Milan, Italy. Electronic address: davide.chiumello@unimi.it. 2. SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy. 3. SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy. 4. Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.
Abstract
PURPOSE: Aim of this study was to evaluate the effect of acute respiratory distress syndrome (ARDS) duration on gas-exchange, respiratory mechanics, specific lung elastance and mechanical power. MATERIALS AND METHODS: In a single center prospective study 28 ARDS patients (66.4 ± 10.0 years, BMI 23.6[21.3-28.8] kg/m2, PaO2/FiO2 148.9[99.6-173.5]) who still presented ARDS criteria after 7-days of mechanical ventilation were studied in early and persistent phase of the disease (day-1 and after 7-days). Each patient underwent PEEP trial at 5-15 cmH2O in both phases. RESULTS: At both PEEP levels the PaO2 was similar in both phases (early: 70.7[65.1-84.4] vs 102.0[85.5-131.8] mmHg; persistent 70.7[63.0-76.2] vs 97.4[86.5-117.1] mmHg, 5-15 cmH2O respectively), the PaCO2 was significantly higher in the persistent phase at both PEEP levels (early 50.6 ± 10.2 vs 52.1 ± 10.5 mmHg; persistent 57.7 ± 13.4 vs 56.9 ± 12.8 mmHg). Specific lung elastance was not different in the early compared to the persistent phase 12.5 ± 3.1 vs 12.2 ± 3.8 cmH2O. The mechanical power normalized for the functional residual capacity increased with PEEP and was similar in both phases (early 23.4[12.8-32.8] vs 34.3[25.3-47.9], persistent 16.3[10.9-24.1] vs 26.7[19.9-46.0] J/min/L, 5-15 cmH2O respectively). CONCLUSIONS: The persistent phase of ARDS for 7-days did not affect the respiratory mechanics while significantly impaired the PaCO2 exchange.
PURPOSE: Aim of this study was to evaluate the effect of acute respiratory distress syndrome (ARDS) duration on gas-exchange, respiratory mechanics, specific lung elastance and mechanical power. MATERIALS AND METHODS: In a single center prospective study 28 ARDSpatients (66.4 ± 10.0 years, BMI 23.6[21.3-28.8] kg/m2, PaO2/FiO2 148.9[99.6-173.5]) who still presented ARDS criteria after 7-days of mechanical ventilation were studied in early and persistent phase of the disease (day-1 and after 7-days). Each patient underwent PEEP trial at 5-15 cmH2O in both phases. RESULTS: At both PEEP levels the PaO2 was similar in both phases (early: 70.7[65.1-84.4] vs 102.0[85.5-131.8] mmHg; persistent 70.7[63.0-76.2] vs 97.4[86.5-117.1] mmHg, 5-15 cmH2O respectively), the PaCO2 was significantly higher in the persistent phase at both PEEP levels (early 50.6 ± 10.2 vs 52.1 ± 10.5 mmHg; persistent 57.7 ± 13.4 vs 56.9 ± 12.8 mmHg). Specific lung elastance was not different in the early compared to the persistent phase 12.5 ± 3.1 vs 12.2 ± 3.8 cmH2O. The mechanical power normalized for the functional residual capacity increased with PEEP and was similar in both phases (early 23.4[12.8-32.8] vs 34.3[25.3-47.9], persistent 16.3[10.9-24.1] vs 26.7[19.9-46.0] J/min/L, 5-15 cmH2O respectively). CONCLUSIONS: The persistent phase of ARDS for 7-days did not affect the respiratory mechanics while significantly impaired the PaCO2 exchange.
Authors: Benjamin P Wankum; Riley E Reynolds; Andrea R McCain; Nathaniel T Zollinger; Keely L Buesing; Russel D Sindelar; Frank M Freihaut; Tariku Fekadu; Benjamin S Terry Journal: J Anesth Date: 2021-06-01 Impact factor: 2.078