Effect of Tidal Volume on Gas Exchange and Oxygen Transport in the Adult Respiratory Distress Syndrome

Kiiski, Ritva; Takala, Jukka; Kari, A.; Milic–Emili, J.

doi:10.1164/ajrccm/146.5_pt_1.1131

Cited by 72 publications

(29 citation statements)

References 9 publications

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“…Tidal volume reduction from 14 mL/kg to 11 mL/kg (with PEEP ϭ 15 cm H 2 O) improved oxygen delivery in patients with ARDS because of increased lung compliance and better hemodynamics (12). Improvement in cardiac output has been observed without significant change in arterial Po 2 (26,27).…”

Section: Hemodynamic Effectsmentioning

confidence: 90%

Hemodynamic Impact of Mechanical Ventilation in the Acute Respiratory Distress Syndrome

Sasidhar¹,

Papa-Kanaan²,

Waxman³

2003

Clinical Pulmonary Medicine

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Recent data show that mortality from adult respiratory distress syndrome has declined over the years yet these patients continue to be a challenge for physicians. Mechanical ventilatory support is required to maintain oxygenation and support respiratory workload. However, experimental data, largely from animal studies, have shown that lung injury can be induced by mechanical ventilation and positive pressure ventilation may worsen the hemodynamic status of an already unstable patient. Some ventilatory strategies may be more deleterious than others. Using the evidence from experimental and clinical studies, a "lung protective" strategy of mechanical ventilation has been proposed combining low tidal volumes to limit stretch and adequate levels of positive end-expiratory pressure to prevent alveolar collapse. This strategy may also limit end organ damage and promote hemodynamic stability. Clin Pulm Med 2003;10(3):154-161

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Section: Hemodynamic Effectsmentioning

confidence: 90%

Hemodynamic Impact of Mechanical Ventilation in the Acute Respiratory Distress Syndrome

Sasidhar¹,

Papa-Kanaan²,

Waxman³

2003

Clinical Pulmonary Medicine

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“…While body weight was not provided, these tidal volumes were certainly higher than the 6 ml/kg predicted body weight currently used to treat ARDS. Since high tidal volumes are known to decrease venous admixture and cardiac output (13,14), and since cardiac output may have an important effect on the degree of shunt (see below), the relative extent of shunt and low V A /Q measured by Dantzker and colleagues (12) may be different than that observed in patients receiving lower tidal volumes. Interestingly, the subgroup of five patients studied by Dantzker and colleagues (12) on no PEEP, while breathing less than 100% O 2 , had mean percent shunts and ventilation of underperfused lung regions that were not significantly different from the subgroup receiving PEEP and/or 100% O 2 (although increasing PEEP within a given patient did have important effects, see below).…”

Section: Gas Exchange Abnormalities Shunt and Low Ventilation-to-perfmentioning

confidence: 99%

Gas Exchange in the Respiratory Distress Syndromes

Albert

Jobe

2012

Comprehensive Physiology

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This article describes the gas exchange abnormalities occurring in the acute respiratory distress syndrome seen in adults and children and in the respiratory distress syndrome that occurs in neonates. Evidence is presented indicating that the major gas exchange abnormality accounting for the hypoxemia in both conditions is shunt, and that approximately 50% of patients also have lungs regions in which low ventilation-to-perfusion ratios contribute to the venous admixture. The various mechanisms by which hypercarbia may develop and by which positive end-expiratory pressure improves gas exchange are reviewed, as are the effects of vascular tone and airway narrowing. The mechanisms by which surfactant abnormalities occur in the two conditions are described, as are the histological findings that have been associated with shunt and low ventilation-to-perfusion.

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“…Lung overstretching and overdistension are significant in causing lung injury rather than high pressures alone; volume trauma is at least as important as barotrauma (14). Acute respiratory distress syndrome (ARDS) (15)(16)(17)(18)(19), asthma (20), acute lung injury (21), and severe air flow obstruction (20, 21) should be taken into account, with tidal volumes and peak pressures reduced to a minimum.…”

Section: Ventilation-induced Lung Injurymentioning

confidence: 99%