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Carvalho, Alysson R.; Jandre, Frederico C.; Pino, Alexandre Visintainer; Bozza, Fernando A.; Salluh, Jorge I.; Rodrigues, Rosana Souza; Soares, Jorge; Giannella-Neto, Antonio

doi:10.1186/cc5030

Cited by 43 publications

(15 citation statements)

References 22 publications

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“…In agreement with our previous works [9], the hyperinflation induced by PEEP was associated with an increase in Ers. When animals were ventilated with PEEP < 6 cmH 2 O, the increase of poorly aerated areas was also associated with an increase of Ers.…”

Section: Discussionsupporting

confidence: 93%

“…The PEEP at which Ers was minimal corresponded to the best compromise between recruitment and hyperinflation [9], and was close to the PEEP at which the stress index and % E 2 indicated a straight Paw curve.…”

Section: Discussionmentioning

confidence: 88%

“…Alternatively, the linear Ers may be also useful to guide PEEP titration [9–11]. It was claimed that PEEP at which Ers is minimal corresponds to a compromise between the distribution of aeration and mechanical stress [9, 10].…”

Section: Introductionmentioning

confidence: 99%

“…It was claimed that PEEP at which Ers is minimal corresponds to a compromise between the distribution of aeration and mechanical stress [9, 10]. …”

Section: Introductionmentioning

confidence: 99%

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Ability of dynamic airway pressure curve profile and elastance for positive end-expiratory pressure titration

et al. 2008

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Objective To evaluate the ability of three indices derived from the airway pressure curve for titrating positive end-expiratory pressure (PEEP) to minimize mechanical stress while improving lung aeration assessed by computed tomography (CT). Design Prospective, experimental study. Setting University research facilities. Subjects Twelve pigs. Interventions Animals were anesthetized and mechanically ventilated with tidal volume of 7 ml kg−1. In non-injured lungs (n = 6), PEEP was set at 16 cmH2O and stepwise decreased until zero. Acute lung injury was then induced either with oleic acid (n = 6) or surfactant depletion (n = 6). A recruitment maneuver was performed, the PEEP set at 26 cmH2O and decreased stepwise until zero. CT scans were obtained at end-expiratory and end-inspiratory pauses. The elastance of the respiratory system (Ers), the stress index and the percentage of volume-dependent elastance (%E2) were estimated. Measurements and main results In non-injured and injured lungs, the PEEP at which Ers was lowest (8–4 and 16–12 cmH2O, respectively) corresponded to the best compromise between recruitment/hyperinflation. In non-injured lungs, stress index and %E2 correlated with tidal recruitment and hyperinflation. In injured lungs, stress index and %E2 suggested overdistension at all PEEP levels, whereas the CT scans evidenced tidal recruitment and hyperinflation simultaneously. Conclusion During ventilation with low tidal volumes, Ers seems to be useful for guiding PEEP titration in non-injured and injured lungs, while stress index and %E2 are useful in non-injured lungs only. Our results suggest that Ers can be superior to the stress index and %E2 to guide PEEP titration in focal loss of lung aeration.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

“…It was claimed that PEEP at which Ers is minimal corresponds to a compromise between the distribution of aeration and mechanical stress [9, 10]. …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ability of dynamic airway pressure curve profile and elastance for positive end-expiratory pressure titration

et al. 2008

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“…The current findings that recruitment and PEEP decrease airspace distension, coupled with recent indications that lung recruitment in anesthetized patients may improve postoperative lung function, 38 may together suggest that techniques enabling titration of recruitment (or PEEP) against airspace micromechanics may ultimately help to translate the experimental benefits of PEEP into clinical practice. In the interim, setting PEEP on a descending ramp after recruitment —shown to optimize gas exchange and lung aeration in healthy lungs 39 — may be a reasonable choice for lung protection during surgical anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Positive End-expiratory Pressure Increments during Anesthesia in Normal Lung Result in Hysteresis and Greater Numbers of Smaller Aerated Airspaces

et al. 2013

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Background While it is recognized that pulmonary hysteresis can influence the effects of positive end-expiratory pressure (PEEP), the extent to which expansion of previously opened (vs. newly opening) peripheral airspaces contribute to increased lung volume is not known. Methods Following a recruitment maneuver, rats were ventilated with constant tidal volumes and imaged during ascending and descending ramps of PEEP. Results We estimated peripheral airspace dimensions by measuring the apparent diffusion coefficient (ADC) of 3He in 10 rats. In a separate group (n = 5) undergoing a similar protocol, we used computerized tomography to quantify lung volume. Hysteresis was confirmed by larger end-inspiratory lung volume (mean ± SD; all PEEP levels included): 8.4 ± 2.8 versus 6.8 ± 2.0 mL (P < 0.001) and dynamic compliance: 0.52 ± 0.12 versus 0.42 ± 0.09 mL/cmH2O (P < 0.001) during descending versus ascending PEEP ramps. ADC increased with PEEP but it was smaller during the descending versus ascending ramps for corresponding levels of PEEP: 0.168 ± 0.019 versus 0.183 ± 0.019 cm2/s (P < 0.001). ADC was smaller in the posterior versus anterior lung regions, but the effect of PEEP and hysteresis on ADC was greater in the posterior regions. Conclusions Our results suggest that in healthy lungs, larger lung volumes due to hysteresis are associated with smaller individual airspaces. This may be explained by opening of previously non-aerated peripheral airspaces, rather than expansion of those already aerated. Setting PEEP on a descending ramp may minimize distension of individual airspaces.

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Effect of a Lower vs Higher Positive End-Expiratory Pressure Strategy on Ventilator-Free Days in ICU Patients Without ARDS

Algera

Pisani

Neto

et al. 2020

JAMA

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Key PointsQuestionIn patients in the intensive care unit (ICU) who received invasive ventilation for reasons other than acute respiratory distress syndrome, is a ventilation strategy with lower positive end-expiratory pressure (PEEP) noninferior to a strategy using higher PEEP with respect to the number of ventilator-free days at day 28?FindingsIn this randomized clinical trial that included 980 ICU patients receiving invasive ventilation and who were expected not to be extubated within 24 hours of randomization, a ventilation strategy using lower PEEP compared with a strategy using higher PEEP resulted in 18 vs 17 ventilator-free days at day 28, a difference that did not exceed the noninferiority margin of −10%.MeaningAmong patients in the ICU receiving invasive ventilation, a strategy with lower PEEP was noninferior to a strategy using higher PEEP.

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Cited by 43 publications

References 22 publications

Ability of dynamic airway pressure curve profile and elastance for positive end-expiratory pressure titration

Ability of dynamic airway pressure curve profile and elastance for positive end-expiratory pressure titration

Positive End-expiratory Pressure Increments during Anesthesia in Normal Lung Result in Hysteresis and Greater Numbers of Smaller Aerated Airspaces

Effect of a Lower vs Higher Positive End-Expiratory Pressure Strategy on Ventilator-Free Days in ICU Patients Without ARDS

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