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- Title
Optimisation of positive end-expiratory pressure by forced oscillation technique in a lavage model of acute lung injury.
- Authors
Dellacà, Raffaele L.; Zannin, Emanuela; Kostic, Peter; Andersson Olerud, Marie; Pompilio, Pasquale P.; Hedenstierna, Goran; Pedotti, Antonio; Frykholm, Peter
- Abstract
Purpose: We evaluated whether oscillatory compliance (C) measured by forced oscillation technique (FOT) at 5 Hz may be useful for positive end-expiratory pressure (PEEP) optimisation. Methods: We studied seven pigs in which lung injury was induced by broncho-alveolar lavage. The animals were ventilated in volume control mode with a tidal volume of 6 ml/kg. Forced oscillations were superimposed on the ventilation waveform for the assessment of respiratory mechanics. PEEP was increased from 0 to 24 cmHO in steps of 4 cmHO and subsequently decreased from 24 to 0 in steps of 2 cmHO. At each 8-min step, a CT scan was acquired during an end-expiratory hold, and blood gas analysis was performed. C was monitored continuously, and data relative to the expiratory hold were selected and averaged for comparison with CT and oxygenation. Results: Open lung PEEP (PEEP) was defined as the level of PEEP corresponding to the maximum value of C on the decremental limb of the PEEP trial. PEEP was on average 13.4 (±1.0) cmHO. For higher levels of PEEP, there were no significant changes in the amount of non-aerated tissue (V%). In contrast, when PEEP was reduced below PEEP, V% dramatically increased. PEEP was able to prevent a 5% drop in V% with 100% sensitivity and 92% specificity. At PEEP V% was significantly lower than at the corresponding PEEP level on the incremental limb. Conclusions: The assessment of C allowed the definition of PEEP to be in agreement with CT data. Thus, FOT measurements of C may provide a non-invasive bedside tool for PEEP titration.
- Subjects
LUNG injury treatment; VENTILATION; BRONCHOALVEOLAR lavage; VOLUMETRIC analysis; BLOOD gases analysis; OXYGEN therapy
- Publication
Intensive Care Medicine, 2011, Vol 37, Issue 6, p1021
- ISSN
0342-4642
- Publication type
Article
- DOI
10.1007/s00134-011-2211-7