Effect of PEEP and tidal volume on ventilation distribution and end-expiratory lung volume: a prospective experimental animal and pilot clinical study.

<h4>Introduction</h4>Lung-protective ventilation aims at using low tidal volumes (VT) at optimum positive end-expiratory pressures (PEEP). Optimum PEEP should recruit atelectatic lung regions and avoid tidal recruitment and end-inspiratory overinflation. We examined the effect of VT and...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Günther Zick, Gunnar Elke, Tobias Becher, Dirk Schädler, Sven Pulletz, Sandra Freitag-Wolf, Norbert Weiler, Inéz Frerichs
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/c79045a9ed9e402ca5cd8c8438a1c0c2
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:c79045a9ed9e402ca5cd8c8438a1c0c2
record_format	dspace
spelling	oai:doaj.org-article:c79045a9ed9e402ca5cd8c8438a1c0c22021-11-18T08:58:25ZEffect of PEEP and tidal volume on ventilation distribution and end-expiratory lung volume: a prospective experimental animal and pilot clinical study.1932-620310.1371/journal.pone.0072675https://doaj.org/article/c79045a9ed9e402ca5cd8c8438a1c0c22013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23991138/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Introduction</h4>Lung-protective ventilation aims at using low tidal volumes (VT) at optimum positive end-expiratory pressures (PEEP). Optimum PEEP should recruit atelectatic lung regions and avoid tidal recruitment and end-inspiratory overinflation. We examined the effect of VT and PEEP on ventilation distribution, regional respiratory system compliance (C(RS)), and end-expiratory lung volume (EELV) in an animal model of acute lung injury (ALI) and patients with ARDS by using electrical impedance tomography (EIT) with the aim to assess tidal recruitment and overinflation.<h4>Methods</h4>EIT examinations were performed in 10 anaesthetized pigs with normal lungs ventilated at 5 and 10 ml/kg body weight VT and 5 cmH2O PEEP. After ALI induction, 10 ml/kg VT and 10 cmH2O PEEP were applied. Afterwards, PEEP was set according to the pressure-volume curve. Animals were randomized to either low or high VT ventilation changed after 30 minutes in a crossover design. Ventilation distribution, regional C(RS) and changes in EELV were analyzed. The same measures were determined in five ARDS patients examined during low and high VT ventilation (6 and 10 (8) ml/kg) at three PEEP levels.<h4>Results</h4>In healthy animals, high compared to low VT increased C(RS) and ventilation in dependent lung regions implying tidal recruitment. ALI reduced C(RS) and EELV in all regions without changing ventilation distribution. Pressure-volume curve-derived PEEP of 21±4 cmH2O (mean±SD) resulted in comparable increase in C(RS) in dependent and decrease in non-dependent regions at both VT. This implied that tidal recruitment was avoided but end-inspiratory overinflation was present irrespective of VT. In patients, regional C(RS) differences between low and high VT revealed high degree of tidal recruitment and low overinflation at 3±1 cmH2O PEEP. Tidal recruitment decreased at 10±1 cmH2O and was further reduced at 15±2 cmH(2)O PEEP.<h4>Conclusions</h4>Tidal recruitment and end-inspiratory overinflation can be assessed by EIT-based analysis of regional C(RS).Günther ZickGunnar ElkeTobias BecherDirk SchädlerSven PulletzSandra Freitag-WolfNorbert WeilerInéz FrerichsPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 8, p e72675 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Günther Zick Gunnar Elke Tobias Becher Dirk Schädler Sven Pulletz Sandra Freitag-Wolf Norbert Weiler Inéz Frerichs Effect of PEEP and tidal volume on ventilation distribution and end-expiratory lung volume: a prospective experimental animal and pilot clinical study.
description	<h4>Introduction</h4>Lung-protective ventilation aims at using low tidal volumes (VT) at optimum positive end-expiratory pressures (PEEP). Optimum PEEP should recruit atelectatic lung regions and avoid tidal recruitment and end-inspiratory overinflation. We examined the effect of VT and PEEP on ventilation distribution, regional respiratory system compliance (C(RS)), and end-expiratory lung volume (EELV) in an animal model of acute lung injury (ALI) and patients with ARDS by using electrical impedance tomography (EIT) with the aim to assess tidal recruitment and overinflation.<h4>Methods</h4>EIT examinations were performed in 10 anaesthetized pigs with normal lungs ventilated at 5 and 10 ml/kg body weight VT and 5 cmH2O PEEP. After ALI induction, 10 ml/kg VT and 10 cmH2O PEEP were applied. Afterwards, PEEP was set according to the pressure-volume curve. Animals were randomized to either low or high VT ventilation changed after 30 minutes in a crossover design. Ventilation distribution, regional C(RS) and changes in EELV were analyzed. The same measures were determined in five ARDS patients examined during low and high VT ventilation (6 and 10 (8) ml/kg) at three PEEP levels.<h4>Results</h4>In healthy animals, high compared to low VT increased C(RS) and ventilation in dependent lung regions implying tidal recruitment. ALI reduced C(RS) and EELV in all regions without changing ventilation distribution. Pressure-volume curve-derived PEEP of 21±4 cmH2O (mean±SD) resulted in comparable increase in C(RS) in dependent and decrease in non-dependent regions at both VT. This implied that tidal recruitment was avoided but end-inspiratory overinflation was present irrespective of VT. In patients, regional C(RS) differences between low and high VT revealed high degree of tidal recruitment and low overinflation at 3±1 cmH2O PEEP. Tidal recruitment decreased at 10±1 cmH2O and was further reduced at 15±2 cmH(2)O PEEP.<h4>Conclusions</h4>Tidal recruitment and end-inspiratory overinflation can be assessed by EIT-based analysis of regional C(RS).
format	article
author	Günther Zick Gunnar Elke Tobias Becher Dirk Schädler Sven Pulletz Sandra Freitag-Wolf Norbert Weiler Inéz Frerichs
author_facet	Günther Zick Gunnar Elke Tobias Becher Dirk Schädler Sven Pulletz Sandra Freitag-Wolf Norbert Weiler Inéz Frerichs
author_sort	Günther Zick
title	Effect of PEEP and tidal volume on ventilation distribution and end-expiratory lung volume: a prospective experimental animal and pilot clinical study.
title_short	Effect of PEEP and tidal volume on ventilation distribution and end-expiratory lung volume: a prospective experimental animal and pilot clinical study.
title_full	Effect of PEEP and tidal volume on ventilation distribution and end-expiratory lung volume: a prospective experimental animal and pilot clinical study.
title_fullStr	Effect of PEEP and tidal volume on ventilation distribution and end-expiratory lung volume: a prospective experimental animal and pilot clinical study.
title_full_unstemmed	Effect of PEEP and tidal volume on ventilation distribution and end-expiratory lung volume: a prospective experimental animal and pilot clinical study.
title_sort	effect of peep and tidal volume on ventilation distribution and end-expiratory lung volume: a prospective experimental animal and pilot clinical study.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/c79045a9ed9e402ca5cd8c8438a1c0c2
work_keys_str_mv	AT guntherzick effectofpeepandtidalvolumeonventilationdistributionandendexpiratorylungvolumeaprospectiveexperimentalanimalandpilotclinicalstudy AT gunnarelke effectofpeepandtidalvolumeonventilationdistributionandendexpiratorylungvolumeaprospectiveexperimentalanimalandpilotclinicalstudy AT tobiasbecher effectofpeepandtidalvolumeonventilationdistributionandendexpiratorylungvolumeaprospectiveexperimentalanimalandpilotclinicalstudy AT dirkschadler effectofpeepandtidalvolumeonventilationdistributionandendexpiratorylungvolumeaprospectiveexperimentalanimalandpilotclinicalstudy AT svenpulletz effectofpeepandtidalvolumeonventilationdistributionandendexpiratorylungvolumeaprospectiveexperimentalanimalandpilotclinicalstudy AT sandrafreitagwolf effectofpeepandtidalvolumeonventilationdistributionandendexpiratorylungvolumeaprospectiveexperimentalanimalandpilotclinicalstudy AT norbertweiler effectofpeepandtidalvolumeonventilationdistributionandendexpiratorylungvolumeaprospectiveexperimentalanimalandpilotclinicalstudy AT inezfrerichs effectofpeepandtidalvolumeonventilationdistributionandendexpiratorylungvolumeaprospectiveexperimentalanimalandpilotclinicalstudy
_version_	1718421108703625216

Effect of PEEP and tidal volume on ventilation distribution and end-expiratory lung volume: a prospective experimental animal and pilot clinical study.

Ejemplares similares