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- Title
Monitoring dead space during recruitment and PEEP titration in an experimental model.
- Authors
Tusman, Gerardo; Suarez-Sipmann, Fernando; Böhm, Stephan H.; Pech, Tanja; Reissmann, Hajo; Meschino, Gustavo; Scandurra, Adriana; Hedenstierna, Göran; Böhm, Stephan H; Hedenstierna, Göran
- Abstract
<bold>Objective: </bold>To test the usefulness of dead space for determining open-lung PEEP, the lowest PEEP that prevents lung collapse after a lung recruitment maneuver.<bold>Design: </bold>Prospective animal study.<bold>Setting: </bold>Department of Clinical Physiology, University of Uppsala, Sweden.<bold>Subjects: </bold>Eight lung-lavaged pigs.<bold>Interventions: </bold>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.<bold>Measurements and Results: </bold>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.<bold>Conclusions: </bold>Monitoring of dead space was useful for detecting lung collapse and for establishing open-lung PEEP after a recruitment maneuver.
- Subjects
LUNG transplantation; PULMONARY function tests; ATELECTASIS; ARTIFICIAL respiration; LUNG disease diagnosis; RESPIRATORY intensive care; OXYGEN therapy; EQUIPMENT &; supplies; ADULT respiratory distress syndrome treatment; AIRWAY (Anatomy); ANIMAL experimentation; COMPARATIVE studies; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; PULMONARY alveoli; PULMONARY gas exchange; RESEARCH; RESPIRATION; RESPIRATORY measurements; SWINE; EVALUATION research; RECEIVER operating characteristic curves; POSITIVE end-expiratory pressure; PREVENTION
- Publication
Intensive Care Medicine, 2006, Vol 32, Issue 11, p1863
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-006-0371-7