Alveolar recruitment in acute lung injury

Mols, Georg; Priebe, Hans‐Joachim; Guttmann, J.

doi:10.1093/bja/aei299

Cited by 118 publications

(83 citation statements)

References 121 publications

(60 reference statements)

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“…Furthermore, development of techniques for direct bedside monitoring of alveolar dynamics would be a major step forward in clinical ventilator management (20).…”

Section: Clinical Relevancementioning

confidence: 99%

Alveolar Dynamics during Respiration

Namati¹,

Thiesse²,

Ryk³

et al. 2008

Am J Respir Cell Mol Biol

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The change in alveolar size and number during the full breathing cycle in mammals remains unanswered, yet these descriptors are fundamental for understanding alveolar-based diseases and for improving ventilator management. Genetic and environmental mouse models are used increasingly to evaluate the evolution of disease in the peripheral lung; however, little is known regarding alveolar structure and function in the fresh, intact lung. Therefore, we have developed an optical confocal process to evaluate alveolar dynamics in the fresh intact mouse lung and as an initial experiment, have evaluated mouse alveolar dynamics during a single respiratory cycle immediately after passive lung deflation. We observe that alveoli become smaller and more numerous at the end of inspiration, and propose that this is direct evidence for alveolar recruitment in the mouse lung. The findings reported support a new hypothesis that requires recruitable secondary (daughter) alveoli to inflate via primary (mother) alveoli rather than from a conducting airway.

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“…Furthermore, development of techniques for direct bedside monitoring of alveolar dynamics would be a major step forward in clinical ventilator management (20).…”

Section: Clinical Relevancementioning

confidence: 99%

Alveolar Dynamics during Respiration

Namati¹,

Thiesse²,

Ryk³

et al. 2008

Am J Respir Cell Mol Biol

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“…It is believed that the use of these strategies in clinical practice determines an important reduction of morbidity and mortality [19,20].…”

Section: Indicationsmentioning

confidence: 99%

“…PEEP provides higher alveolar stability after the recruitment. The ideal PEEP can be determined by the best gas exchange point, in other words, 2 cmH2O above the lower inflection point of pressure-volume curve of the respiratory system, observing the hemodynamic stability [10,20,26 Benefits Studies have shown that alveolar recruitment strategies can improve respiratory function in the postoperative period of cardiac surgery by reducing atelectasis and intrapulmonary shunt, improving ventilation-perfusion ratio and, consequently, arterial oxygenation [11,13,16].…”

Section: Adverse Effects and Contraindicationsmentioning

confidence: 99%

Recrutamento alveolar em pacientes no pós-operatório imediato de cirurgia cardíaca

Padovani¹,

Cavenaghi²

2011

Rev Bras Cir Cardiovasc

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“…Ventilator settings are often adjusted to achieve predestined arterial blood gas tensions. This approach is adequate with respect to oxygenation and carbon dioxide elimination [4].…”

Section: Introductionmentioning

confidence: 99%

Effects of a Combination of Prone Positioning and High-Frequency Oscillatory Ventilation on Blood Gas Exchange in an Experimental Pig Model of Acute Respiratory Distress Syndrome Efekti Kombinacije Ležećeg Položaja I Oscilatorne Plućne Ventilacije Visoke Frekvencije Na Razmenu Gasova U Krvi Na Modelu Sindroma Akutnog Respiratornog Šoka Kod Svinja

et al. 2014

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This animal study was conducted in order to verify the effects of combining highfrequency oscillatory ventilation and prone positioning and the order of application of both methods on blood gas exchange in an experimental model of acute respiratory distress syndrome.Forty domestic pigs were used for the study. Saline solution washout was produced by bilateral lung lavage. The lavage process was repeated until adequate impairment of gas exchange (defi ned as PaO2 < 100 mmHg) 60 min following the last lavage was achieved. Subsequently, lung injury was established and each model was randomized to one of fi ve groups, with differences in the type of mechanical ventilation used (conventional mechanical ventilation in accordance with the principles of protective lung ventilation or high-frequency oscillatory ventilation) and also in the positioning of the experimental model (supine position or mode changing prone and supine positions in a ratio 18:6 hours).The best oxygenation was achieved in the group prone position + high-frequency oscillatory ventilation. The most favorable combination in terms of carbon dioxide elimination is the high-frequency oscillatory ventilation + prone position. The best results in terms of oxygenation index value were obtained in the combination of a prone position with the high-frequency oscillatory ventilation and in the prone position.In conclusion, by using combinations of prone positioning and high-frequency oscillatory ventilation, one can achieve better blood gas parameters during acute respiratory distress syndrome.

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Alveolar recruitment in acute lung injury

Cited by 118 publications

References 121 publications

Alveolar Dynamics during Respiration

Alveolar Dynamics during Respiration

Recrutamento alveolar em pacientes no pós-operatório imediato de cirurgia cardíaca

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