Lung stress and strain during mechanical ventilation in animals with and without pulmonary acute respiratory distress syndrome

Liu, Qi; Li, Wen; Zeng, Qing; Zhong, Nanshan; Chen, Rongchang

doi:10.1016/j.jss.2012.07.010

Cited by 11 publications

(6 citation statements)

References 32 publications

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“…This observation suggests strongly that clinicians tend to use lower V t resulting in relatively higher inspiratory airway pressures in the sicker patients (i.e., patients with lower respiratory system compliance) at the onset of mechanical ventilation for ARDS. These findings are consistent with the recent concept of keeping lung tissue strain (i.e., ratio between inflated volume and functional residual capacity) low to protect the lung (34). These findings are consistent with the recent concept of keeping lung tissue strain (i.e., ratio between inflated volume and functional residual capacity) low to protect the lung (34).…”

Section: Ventilatory Strategies During Conventional Ventilationsupporting

confidence: 91%

Ventilatory Support in Children With Pediatric Acute Respiratory Distress Syndrome

Rimensberger

Cheifetz

2015

Pediatric Critical Care Medicine

125

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The Consensus Conference developed pediatric-specific recommendations regarding mechanical ventilation of the patient with pediatric acute respiratory distress syndrome as well as future research priorities. These recommendations are intended to initiate discussion regarding optimal mechanical ventilation management for children with pediatric acute respiratory distress syndrome and identify areas of controversy requiring further investigation.

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Section: Ventilatory Strategies During Conventional Ventilationsupporting

confidence: 91%

Ventilatory Support in Children With Pediatric Acute Respiratory Distress Syndrome

Rimensberger

Cheifetz

2015

Pediatric Critical Care Medicine

125

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“…The TLC was defined for healthy dogs as the lung volume during forced inflation at an airway pressure of 35cmH 2 O. ( 15 ) To test this hypothesis, two healthy dogs that were submitted to ovariectomy or orchiectomy were evaluated to calculate P-V curves and determine the upper inflection points for airway pressure, PiflexSupAw and PiflexSupTP. The assessment of healthy condition consisted of a complete clinical evaluation, thoracic radiographs and arterial blood gas measurements.…”

Section: Methodsmentioning

confidence: 99%

Sizing the lung in dogs: the inspiratory capacity defines the tidal volume

Donati¹,

Gogniat²,

Madorno³

et al. 2018

Revista Brasileira De Terapia Intensiva

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ObjectiveTo evaluate a novel physiological approach for setting the tidal volume in mechanical ventilation according to inspiratory capacity, and to determine if it results in an appropriate mechanical and gas exchange measurements in healthy and critically ill dogs.MethodsTwenty healthy animals were included in the study to assess the tidal volume expressed as a percentage of inspiratory capacity. For inspiratory capacity measurement, the mechanical ventilator was set as follows: pressure control mode with 35cmH2O of inspired pressure and zero end-expiratory pressure for 5 seconds. Subsequently, the animals were randomized into four groups and ventilated with a tidal volume corresponding to the different percentages of inspiratory capacity. Subsequently, ten critically ill dogs were studied.ResultsHealthy dogs ventilated with a tidal volume of 17% of the inspiratory capacity showed normal respiratory mechanics and presented expected PaCO2 values more frequently than the other groups. The respiratory system and transpulmonary driving pressure were significantly higher among the critically ill dogs but below 15 cmH2O in all cases.ConclusionsThe tidal volume based on the inspiratory capacity of each animal has proven to be a useful and simple tool when setting ventilator parameters. A similar approach should also be evaluated in other species, including human beings, if we consider the potential limitations of tidal volume titration based on the calculated ideal body weight.

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“…In ARDS, due to the presence of lung disease, there is a commonly significant and nonuniform reduction in the amount of lung available for ventilation among patients [8]. Therefore, a similar tidal volume (VT) dependent on ideal body weight can vary for different degrees of lung stress [9]. In contrast, driving pressure (DP), which is calculated as end-inspiratory plateau pressure (Pplat) minus applied positive end-expiratory pressure (PEEP) and is equivalent to the ratio between the V T and compliance of the respiratory system, can better reflect lung injury compared to V T adjustments based solely on ideal body weight.…”

Section: Introductionmentioning

confidence: 99%

Higher vs. Lower DP for Ventilated Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

Chen

Wei

Liu

et al. 2019

Emergency Medicine International

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Objectives. Driving pressure (DP) has recently become a promising mediator for the identification of the effects of mechanical ventilation on outcomes in acute respiratory distress syndrome (ARDS). The aim of this study was to systematically and quantitatively update and assess the association between DP and mortality among ventilated patients with ARDS. Methods. PubMed, the Cochrane Library, ISI Web of Knowledge, and Embase were systematically searched from inception to June 2018. Two investigators conducted the literature search study selection, data extraction, and quality evaluation independently. RevMan 5.3 software was used for all statistical analyses. Results. A total of seven studies comprising 8010 patients were included in this meta-analysis. Higher DP showed a significant association with higher mortality (pooled risk ratio, 1.10; 95% [CI], 1.05–1.16; I2 =58%). Sensitivity analysis indicated that one study significantly affected the stability of pooled results. One of the subgroups investigated, ARDS severity, could account for the heterogeneity. An exploratory post hoc subgroup analysis and higher DP significantly increased mortality in the mild to severe ARDS subgroup (RR 1.28; 95% [CI], 1.14–1.43; I2 =0), but not in the moderate to severe ARDS subgroup (RR 1.18; 95% [CI], 0.95–1.46; I2 =52%). Conclusion. Higher DP was significantly associated with an increased risk of death among ventilated patients with ARDS. But it did not seem to predict prognosis to moderate to severe ARDS. Future prospective randomized clinical trials are needed to verify the results of this meta-analysis and address the unresolved questions about optimum cutoff values for DP. Trial Registration. This trial is registered with PROSPERO (CRD42018102146), on 11 August 2018.

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Lung stress and strain during mechanical ventilation in animals with and without pulmonary acute respiratory distress syndrome

Cited by 11 publications

References 32 publications

Ventilatory Support in Children With Pediatric Acute Respiratory Distress Syndrome

Ventilatory Support in Children With Pediatric Acute Respiratory Distress Syndrome

Sizing the lung in dogs: the inspiratory capacity defines the tidal volume

Higher vs. Lower DP for Ventilated Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

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