Positive end-expiratory pressure optimization with forced oscillation technique reduces ventilator induced lung injury a controlled experimental study in pigs with saline lavage lung injury 英文参考文献.docVIP
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Positive end-expiratory pressure optimization with forced oscillation technique reduces ventilator induced lung injury a controlled experimental study in pigs with saline lavage lung injury 英文参考文献
Kosticetal.CriticalCare2011,15:R126
/content/15/3/R126
RESEARCH
OpenAccess
Positiveend-expiratorypressureoptimization
withforcedoscillationtechniquereduces
ventilatorinducedlunginjury:acontrolled
experimentalstudyinpigswithsalinelavage
lunginjury
PeterKostic1,EmanuelaZannin2,MarieAnderssonOlerud1,PasqualePPompilio2,G?ranHedenstierna3,
AntonioPedotti2,AndersLarsson1,PeterFrykholm1andRaffaeleLDellaca2*
Abstract
Introduction:Protocolsusinghighlevelsofpositiveend-expiratorypressure(PEEP)incombinationwithlowtidal
volumeshavebeenshowntoreducemortalityinpatientswithsevereacuterespiratorydistresssyndrome(ARDS).
However,theoptimalmethodforsettingPEEPisyettobedefined.Ithasbeenshownthatrespiratorysystem
reactance(Xrs),measuredbytheforcedoscillationtechnique(FOT)at5Hz,maybeusedtoidentifytheminimal
PEEPlevelrequiredtomaintainlungrecruitment.TheaimofthepresentstudywastoevaluateifusingXrsfor
settingPEEPwouldimprovelungmechanicsandreducelunginjurycomparedtoanoxygenation-basedapproach.
Methods:17pigs,inwhichacutelunginjury(ALI)wasinducedbysalinelavage,werestudied.Animalswere
randomizedintotwogroups:inthefirstPEEPwastitratedaccordingtoXrs(FOTgroup),inthecontrolgroupPEEP
wassetaccordingtotheARDSNetprotocol(ARDSNetgroup).Thedurationofthetrialwas12hours.Inboth
groupsrecruitmentmaneuvers(RM)wereperformedevery2hours,increasingPEEPto20cmH2O.IntheFOT
groupPEEPwastitratedbymonitoringXrswhilePEEPwasreducedfrom20cmH2Oinstepsof2cmH2O.PEEP
wasconsideredoptimalatthestepbeforewhichXrsstartedtodecrease.Ventilatoryparameters,lungmechanics,
bloodgasesandhemodynamicparameterswererecordedhourly.Lunginjurywasevaluatedbyhistopathological
analysis.
Results:ThePEEPlevelssetintheFOTgroupweresignificantlyhighercomparedtothosesetintheARDSNet
groupduringthewholetrial.ThesehighervaluesofPEEPresultedinimprovedlungmechanics,reduceddriving
pressure,improvedoxygenation,withatrendforhigherPaCO2andlowersystemicandpulmonarypressure.After
12hoursofventilation,histopathologicalanalysisshowedasignificantlylowerscoreofl
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