Pulmonar recruitment in acute respiratory distress syndrome. What is the best strategy?

Santos, Carlos Antônio Cabral; Samary, Cynthia dos Santos; Júnior, Pedro Laurindo Fiorio; Santos, Bruna Lourenço; Schanaider, Alberto

doi:10.1590/0100-69912015002010

Cited by 8 publications

(3 citation statements)

References 43 publications

(47 reference statements)

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“…Different recruitment maneuverers are extensively used in intensive care with either changes in PEEP, I:E ratios or tidal volumes or a bit of all three [2,28,29]. There is no real consensus on which RM is the most optimal [1,30,31]. We have observed in this study an increase in particle count when releasing PEEP from a high level to a low level and this nding may contribute to further knowledge about the effect of RM, i.e., increased PEEP to different pressure levels.…”

Section: Discussionmentioning

confidence: 99%

Different particle flow from exhaled air after gradual increase of PEEP during mechanical ventilation

Broberg¹,

Pierre

Fakhro

et al. 2022

Preprint

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Objectives: Detecting particle flow from the airways by none invasively online analysing technique might serve as an additional tool to monitor mechanical ventilation. In the present study we used a customised Pexa (Particles in Exhaled Air), which is an optical particle counter for airway monitoring of particle flow in exhaled air. Positive end expiratory pressure (PEEP) is often used as a tool during recruitment manoeuvre and the aim of this study was to investigate the impact of different levels of PEEP on particle flow in exhaled in an experimental setting.Methods: Five animals received a gradual increase of 5 PEEP to a maximum of 25 PEEP during VCV. Measurements were done before every increase in PEEP in fully anaesthetised domestic pigs. The particle count along with vital parameters and ventilator settings were collected continuously. The particle sizes measured was between 0.41 µm and 4.55 µm.Results: All animals had a significant increase in particle count going from all increased levels of PEEP and back down to baseline PEEP of 5 cmH2O. Here shown with PEEP 15 that had a mean particle count of 401 ± 122 particles compared to after release of PEEP back to 5 with a mean particle count of 5968 ± 1784 (p<0.001). A significant decrease was seen in blood pressure in the higher levels of PEEP compared to PEEP 5 cmH2O.Conclusions: In the present study significant increase in particle count was seen when releasing PEEP back to baseline compared to all levels of PEEP. This finding may indicate that this technique can give diagnostic possibilities for monitoring lung function during mechanical ventilation.

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Section: Discussionmentioning

confidence: 99%

Different particle flow from exhaled air after gradual increase of PEEP during mechanical ventilation

Broberg¹,

Pierre

Fakhro

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…An incremental PEEP trial was performed starting at a pressure of 5-8 cmH 2 O with steps of 2 cmH 2 O till the plateau pressure reached 35 cmH 2 O for 2 min or unstable blood pressure was observed [21]. Haemodynamic was monitored with IntelliVue MX800 (Philips Medizin Systeme Böblingen GmbH, Böblingen, Germany).…”

Section: Methodsmentioning

confidence: 99%

The incidence and interpretation of large differences in EIT-based measures for PEEP titration in ARDS patients

Zhao

Lee

Chang

et al. 2019

J Clin Monit Comput

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Positive end-expiratory pressure (PEEP) can be titrated by electrical impedance tomography (EIT). The aim of the present study was to examine the performance of different EIT measures during PEEP trials with the aim of identifying "optimum" PEEP and to provide possible interpretations of largely diverging results. After recruitment (maximum plateau pressure 35 cmH 2 O), decremental PEEP trial with steps of 2 cmH 2 O and duration of 2 min per step was performed. Ventilation gain and loss, the global inhomogeneity (GI) index, trend of end-expiratory lung impedance (EELI) and regional compliance (C reg ) for estimation of overdistension and collapse were calculated. Largely diverging results of PEEP selection among the measures were defined as differences ≥ 4 PEEP steps (i.e. ≥ 8 cmH 2 O). In 30 ARDS patients we examined so far, 3 patients showed significant differences in PEEP selections. Overdistension and collapse estimation based on C reg tended to select lower PEEP while the GI index and EELI trend suggested higher PEEP settings. Regional inspiration times were heterogeneous indicating that the assumption of a uniform driving pressure in the calculation of C reg may not be valid. Judging by the predominant ventilation distribution in the most dependent regions, these patients were non-recruitable with the applied recruitment method or pressure levels. The existence of differences in the recommended PEEP among the analyzed EIT measures might be an indicator of non-recruitable lungs and heterogeneous airway resistances. In these extreme cases, the largely diverging results may prompt the attending clinician to develop individual ventilation strategies. Clinical Trial Registration Registration number NCT03112512, https ://clini caltr ials.gov/ Registered 13 April 2017.

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“…A manobra de recrutamento alveolar através de suspiro é considerada por alguns autores como "mais fisiológica" 9 . O papel do suspiro durante a VM em pacientes com SDRA tem sido enfatizado e a entrega automática e periódica desses suspiros por um ventilador pode ser considerada como um possível componente da estratégia ventilatória nestes pacientes 10 .…”

Section: Introductionunclassified

Recrutamento alveolar com suspiro: impacto na mecânica respiratória e oxigenação de pacientes ventilados mecanicamente

Neto¹,

Avena

Mendes³

et al. 2021

Rev Pesq Fisio

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INTRODUÇÃO: O suspiro caracteriza-se pela realização de uma inspiração lenta e profunda, seguida de uma expiração lenta. Estudos sugerem que a adição de um suspiro por minuto em pacientes com síndrome do desconforto respiratório agudo, ventilados em PSV, melhora a oxigenação e a mecânica pulmonar. OBJETIVO: Avaliar o impacto da manobra de recrutamento alveolar através de suspiro na mecânica pulmonar e oxigenação em pacientes ventilados mecanicamente, além de verificar o impacto hemodinâmico e a incidência de intercorrências associadas à utilização da técnica. MATERIAIS E MÉTODOS: Estudo experimental com 17 pacientes em ventilação mecânica, apresentando relação entre pressão parcial de oxigênio alveolar e fração inspirada de oxigênio (PaO2/FiO2) inferior a 300mmHg. Avaliou-se dados respiratórios, de mecânica pulmonar e hemodinâmicos. Os dados foram coletados durante três períodos: antes do suspiro, imediatamente após e 15 minutos depois da técnica. Dois suspiros por minuto foram administrados utilizando pressão em vias aéreas limitada em 40cmH2O, durante um tempo inspiratório de quatro segundos. RESULTADOS: Após o suspiro observou-se aumento da PaO2, pressão resistiva, complacência estática e relação PaO2/FiO2, além de diminuição da pressão de platô e pressão parcial de gás carbônico alveolar (PaCO2). Após 15 minutos da retirada do suspiro observou-se que a PaO2, pressão resistiva, complacência estática e relação PaO2/FiO2 mantiveram-se acima do valor basal, enquanto que a pressão de platô manteve-se abaixo. Não foi observada alteração significante nas variáveis hemodinâmicas. CONCLUSÃO: O suspiro em pacientes ventilados mecanicamente foi capaz de melhorar a oxigenação e a mecânica pulmonar, sem comprometer a estabilidade hemodinâmica.

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Pulmonar recruitment in acute respiratory distress syndrome. What is the best strategy?

Cited by 8 publications

References 43 publications

Different particle flow from exhaled air after gradual increase of PEEP during mechanical ventilation

Different particle flow from exhaled air after gradual increase of PEEP during mechanical ventilation

The incidence and interpretation of large differences in EIT-based measures for PEEP titration in ARDS patients

Recrutamento alveolar com suspiro: impacto na mecânica respiratória e oxigenação de pacientes ventilados mecanicamente

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