Optimizing positive end-expiratory pressure by oscillatory mechanics minimizes tidal recruitment and distension an experimental study in a lavage model of lung injury 英文参考文献.docVIP

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Optimizing positive end-expiratory pressure by oscillatory mechanics minimizes tidal recruitment and distension an experimental study in a lavage model of lung injury 英文参考文献.doc

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Optimizing positive end-expiratory pressure by oscillatory mechanics minimizes tidal recruitment and distension an experimental study in a lavage model of lung injury 英文参考文献

Zanninetal.CriticalCare2012,16:R217 /content/16/6/R217 RESEARCH OpenAccess Optimizingpositiveend-expiratorypressureby oscillatorymechanicsminimizestidalrecruitment anddistension:anexperimentalstudyinalavage modeloflunginjury EmanuelaZannin1*,RaffaeleLDellaca1,PeterKostic2,PasqualePPompilio1,AndersLarsson2,AntonioPedotti1, GoranHedenstierna3andPeterFrykholm2 Abstract Introduction:Itiswellestablishedthatduringmechanicalventilationofpatientswithacuterespiratorydistress syndromecyclicrecruitment/derecruitmentandoverdistensionarepotentiallyinjuriousforlungtissues.We evaluatedwhethertheforcedoscillationtechnique(FOT)couldbeusedtoguidetheventilatorsettingsinorderto minimizecycliclungrecruitment/derecruitmentandcyclicmechanicalstressinanexperimentalmodelofacute lunginjury. Methods:Westudiedsixpigsinwhichlunginjurywasinducedbybronchoalveolarlavage.Theanimalswere ventilatedwithatidalvolumeof6ml/kg.Forcedoscillationsat5Hzweresuperimposedontheventilation waveform.Pressureandflowweremeasuredatthetipandattheinletoftheendotrachealtuberespectively. Respiratorysystemreactance(Xrs)wascomputedfromthepressureandflowsignalsandexpressedintermsof oscillatoryelastance(EX5).Positiveend-expiratorypressure(PEEP)wasincreasedfrom0to24cmH2Oinstepsof4 cmH2Oandsubsequentlydecreasedfrom24to0instepsof2cmH2O.AteachPEEPstepCTscansandEX5 were assessedatend-expirationandend-inspiration. Results:Duringdeflationtherelationshipbetweenbothend-expiratoryandend-inspiratoryEX5 andPEEPwasaU- shapedcurvewithminimumvaluesatPEEP=13.4±1.0cmH2O(mean±SD)and13.0±1.0cmH2Orespectively. EX5 wasalwayshigheratend-inspirationthanatend-expiration,thedifferencebetweentheaveragecurvesbeing minimalat12cmH2O.AtthisPEEPlevel,CTdidnotshowanysubstantialsignofintra-tidalrecruitment/ derecruitmentorexpiratorylungcollapse. Conclusions:UsingFOTitwaspossibletomeasureEX5 bothatend-expirationandatend-inspiration.Theoptimal PEEPstrategybasedonend-expiratoryEX5 minimizedintra-tidalrecruitment/derecruitmentasassessed