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呼气末正压通气的优化与强迫振荡技术降低了控制通风机诱导肺损伤实验研究猪的生理盐水灌洗肺损伤.pdfVIP

Kostic et al. Critical Care 2011, 15:R126 /content/15/3/R126 RESEARCH Open Access 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 1 2 1 2 3 Peter Kostic , Emanuela Zannin , Marie Andersson Olerud , Pasquale P Pompilio , Göran Hedenstierna , 2 1 1 2* Antonio Pedotti , Anders Larsson , Peter Frykholm and Raffaele L Dellaca Abstract Introduction: Protocols using high levels of positive end-expiratory pressure (PEEP) in combination with low tidal volumes have been shown to reduce mortality in patients with severe acute respiratory distress syndrome (ARDS). However, the optimal method for setting PEEP is yet to be defined. It has been shown that respiratory system reactance (Xrs), measured by the forced oscillation technique (FOT) at 5 Hz, may be used to identify the minimal PEEP level required to maintain lung recruitment. The aim of the present study was to evaluate if using Xrs for setting PEEP would improve lung mechanics and reduce lung injury compared to an oxygenation-based approach. Methods: 17 pigs, in which acute lung injury (ALI) was induced by saline lavage, were studied. Animals were randomized into two groups: in the first PEEP was titrated according to Xrs (FOT group), in the control group PEEP was set according to the ARDSNet protocol (ARDSNet group). The duration of the trial was 12 hours. In both groups recruitment maneuvers (RM) were performed every 2 hours, increasing PEEP to 20 cmH2O. In the FOT group PEEP was titrated by monitoring Xrs while