Preliminary study of ventilation with 4 mlkg tidal volume in acute respiratory distress syndrome feasibility and effects on cyclic recruitment - derecruitment and hyperinflation 英文参考文献.docVIP

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Preliminary study of ventilation with 4 mlkg tidal volume in acute respiratory distress syndrome feasibility and effects on cyclic recruitment - derecruitment and hyperinflation 英文参考文献.doc

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Preliminary study of ventilation with 4 mlkg tidal volume in acute respiratory distress syndrome feasibility and effects on cyclic recruitment - derecruitment and hyperinflation 英文参考文献

Preliminarystudyofventilationwith4ml/kg tidalvolumeinacuterespiratorydistress syndrome:feasibilityandeffectsoncyclic recruitment-derecruitmentandhyperinflation Retamaletal. Retamaletal.CriticalCare2013,17:R16 /content/17/1/R16(28January2013) Retamaletal.CriticalCare2013,17:R16 /content/17/1/R16 RESEARCH OpenAccess Preliminarystudyofventilationwith4ml/kg tidalvolumeinacuterespiratorydistress syndrome:feasibilityandeffectsoncyclic recruitment-derecruitmentandhyperinflation JaimeRetamal1,JavieraLibuy1,MagdalenaJiménez1,MatíasDelgado1,CeciliaBesa2,GuillermoBugedo1and AlejandroBruhn1* Abstract Introduction:Cyclicrecruitment-derecruitmentandoverdistensioncontributetoventilator-inducedlunginjury. Tidalvolume(Vt)mayinfluenceboth,cyclicrecruitment-derecruitmentandoverdistension.Thegoalofthisstudy wastodetermineifdecreasingVtfrom6to4ml/kgreducescyclicrecruitment-derecruitmentandhyperinflation, andifitispossibletoavoidseverehypercapnia. Methods:Patientswithpulmonaryacuterespiratorydistresssyndrome(ARDS)wereincludedinacrossoverstudy withtwoVtlevels:6and4ml/kg.Theprotocolhadtwoparts:onebedsideandotherattheCTroom.Toavoid severehypercapniainthe4ml/kgarm,wereplacedtheheatandmoistureexchangefilterbyaheatedhumidifier, andrespiratoryratewasincreasedtokeepminuteventilationconstant.Dataonlungmechanicsandgasexchange weretakenatbaselineandafter30minutesateachVt(bedside).Thereafter,adynamicCT(4images/secfor8sec) wastakenateachVtatafixedtransverseregionbetweenthemiddleandlowerthirdofthelungs.Afterward,CT imageswereanalyzedandcyclicrecruitment-derecruitmentwasdeterminedasnon-aeratedtissuevariation betweeninspirationandexpiration,andhyperinflationasmaximalhyperinflatedtissueatend-inspiration,expressed as%oflungtissueweight. Results:Weanalyzed10patients.DecreasingVtfrom6to4ml/kgconsistentlydecreasedcyclicrecruitment- derecruitmentfrom3.6(2.5to5.7)%to2.9(0.9to4.7)%(P0.01)andend-inspiratoryhyperinflationfrom0.7(0.3 to2.2)to0.6(0.2to1.7)%(P=0.01).Nopatientdevelopedsevererespiratoryacidosisor