TY - JOUR
T1 - Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome
AU - Terragni, Pier Paolo
AU - Rosboch, Giulio
AU - Tealdi, Andrea
AU - Corno, Eleonora
AU - Menaldo, Eleonora
AU - Davini, Ottavio
AU - Gandini, Giovanni
AU - Herrmann, Peter
AU - Mascia, Luciana
AU - Quintel, Michel
AU - Slutsky, Arthur S.
AU - Gattinoni, Luciano
AU - Ranieri, V. Marco
PY - 2007
Y1 - 2007
N2 - Rationale: Tidal volume and plateau pressure limitation decreases mortality in acute respiratory distress syndrome. Computed tomography demonstrated a small, normally aerated compartment on the top of poorly aerated and nonaerated compartments that may be hyperinflated by tidal inflation. Objectives: We hypothesized that despite tidal volume and plateau pressure limitation, patients with a larger nonaerated compartment are exposed to tidal hyperinflation of the normally aerated compartment. Measurements and Main Results: Pulmonary computed tomography at end-expiration and end-inspiration was obtained in 30 patients ventilated with a low tidal volume (6 ml/kg predicted body weight). Cluster analysis identified 20 patients in whom tidal inflation occurred largely in the normally aerated compartment (69.9 ± 6.9%; "more protected"), and 10 patients in whomtidal inflation occurred largely within the hyperinflated compartments (63.0 ± 12.7%; "less protected"). The nonaerated compartment was smaller and the normally aerated compartment was larger in the more protected patients than in the less protected patients (p = 0.01). Pulmonary cytokines were lower in the more protected patients than in the less protected patients (p <0.05). Ventilator-free days were 7 ± 8 and 1 ± 2 d in the more protected and less protected patients, respectively (p = 0.01). Plateau pressure ranged between 25 and 26 cm H2O in the more protected patients and between 28 and 30 cm H2O in the less protected patients (p = 0.006). Conclusions: Limiting tidal volume to 6 ml/kg predicted body weight and plateau pressure to 30 cm H2O may not be sufficient in patients characterized by a larger nonaerated compartment.
AB - Rationale: Tidal volume and plateau pressure limitation decreases mortality in acute respiratory distress syndrome. Computed tomography demonstrated a small, normally aerated compartment on the top of poorly aerated and nonaerated compartments that may be hyperinflated by tidal inflation. Objectives: We hypothesized that despite tidal volume and plateau pressure limitation, patients with a larger nonaerated compartment are exposed to tidal hyperinflation of the normally aerated compartment. Measurements and Main Results: Pulmonary computed tomography at end-expiration and end-inspiration was obtained in 30 patients ventilated with a low tidal volume (6 ml/kg predicted body weight). Cluster analysis identified 20 patients in whom tidal inflation occurred largely in the normally aerated compartment (69.9 ± 6.9%; "more protected"), and 10 patients in whomtidal inflation occurred largely within the hyperinflated compartments (63.0 ± 12.7%; "less protected"). The nonaerated compartment was smaller and the normally aerated compartment was larger in the more protected patients than in the less protected patients (p = 0.01). Pulmonary cytokines were lower in the more protected patients than in the less protected patients (p <0.05). Ventilator-free days were 7 ± 8 and 1 ± 2 d in the more protected and less protected patients, respectively (p = 0.01). Plateau pressure ranged between 25 and 26 cm H2O in the more protected patients and between 28 and 30 cm H2O in the less protected patients (p = 0.006). Conclusions: Limiting tidal volume to 6 ml/kg predicted body weight and plateau pressure to 30 cm H2O may not be sufficient in patients characterized by a larger nonaerated compartment.
KW - Acute lung injury
KW - Inflammatory response
KW - Mechanical ventilation
KW - Ventilator-induced lung injury
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U2 - 10.1164/rccm.200607-915OC
DO - 10.1164/rccm.200607-915OC
M3 - Article
C2 - 17038660
AN - SCOPUS:33846307424
VL - 175
SP - 160
EP - 166
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
SN - 1073-449X
IS - 2
ER -