Lower tidal volumes for everyone: principle or prescription?

Marini, John J.

doi:10.1007/s00134-012-2754-2

Cited by 10 publications

(6 citation statements)

References 15 publications

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“…For this reason, there is not an ''absolute'' safe value for VT (,6 mL?kg -1 predicted body weight). A dangerous value does not depend on the formula of expected healthy lung size (based on body weight), but on the actual size of aerated alveoli, which depends on the extension of alveolar flooding [22][23][24]. In the same way, the application of higher levels of PEEP could be potentially harmful in patients with low levels of recruitable lung.…”

Section: Computed Tomographymentioning

confidence: 99%

Overview of current lung imaging in acute respiratory distress syndrome

2014

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Imaging plays a key role in the diagnosis and follow-up of acute respiratory distress syndrome (ARDS). Chest radiography, bedside lung ultrasonography and computed tomography scans can provide useful information for the management of patients and detection of prognostic factors. However, imaging findings are not specific and several possible differential diagnoses should be taken into account. Herein we will review the role of radiological techniques in ARDS, highlight the plain radiological and computed tomography findings according to the pathological stage of the disease (exudative, inflammatory and fibroproliferative), and summarise the main points for the differential diagnosis with cardiogenic oedema, which is still challenging in the acute stage. @ERSpublications ARDS diagnosis is still based on radiological criteria; the variety of these findings should be known and recognised

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Section: Computed Tomographymentioning

confidence: 99%

Overview of current lung imaging in acute respiratory distress syndrome

2014

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“… 9 10 However, the opponents contend that lung damage can only be induced with tidal volumes as large as twice the resting aerated compartment, and PV has no additional benefits for healthy lungs. 11 12 Recently, there have been many trials conducted to investigate the effect of PV on clinical outcomes in patients who underwent general anaesthesia, but with conflicting results. The aim of the present study was to synthesise the best evidence in this topic by systematically reviewing these studies.…”

Section: Introductionmentioning

confidence: 99%

Lung protective ventilation in patients undergoing major surgery: a systematic review incorporating a Bayesian approach

Zhang

Xia

et al. 2015

BMJ Open

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ObjectiveProtective ventilation (PV) has been validated in patients with acute respiratory distress syndrome. However, the effect of PV in patients undergoing major surgery is controversial. The study aimed to explore the beneficial effect of PV on patients undergoing a major operation by systematic review and meta-analysis.SettingVarious levels of medical centres.ParticipantsPatients undergoing general anaesthesia.InterventionsPV with low tidal volume.Primary and secondary outcome measuresStudy end points included acute lung injury (ALI), pneumonia, atelectasis, mortality, length of stay (LOS) in intensive care unit (ICU) and hospital.MethodsDatabases including PubMed, Scopus, EBSCO and EMBASE were searched from inception to May 2015. Search strategies consisted of terms related to PV and anaesthesia. We reported OR for binary outcomes including ALI, mortality, pneumonia, atelectasis and other adverse outcomes. Weighted mean difference was reported for continuous outcomes such as LOS in the ICU and hospital, pH value, partial pressure of carbon dioxide, oxygenation and duration of mechanical ventilation (MV).Main resultsA total of 22 citations were included in the systematic review and meta-analysis. PV had protective effect against the development of ALI as compared with the control group, with an OR of 0.41 (95% CI 0.19 to 0.87). PV tended to be beneficial with regard to the development of pneumonia (OR 0.46, 95% CI 0.16 to 1.28) and atelectasis (OR 0.68, 95% CI 0.46 to 1.01), but statistical significance was not reached. Other adverse outcomes such as new onset arrhythmia were significantly reduced with the use of PV (OR 0.47, 95% CI 0.48 to 0.93).ConclusionsThe study demonstrates that PV can reduce the risk of ALI in patients undergoing major surgery. However, there is insufficient evidence that such a beneficial effect can be translated to more clinically relevant outcomes such as mortality or duration of MV.Trial registration numberThe study was registered in PROSPERO (http://www.crd.york.ac.uk/PROSPERO/) under registration number CRD42013006416.

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“…The clinician needs to monitor multiple aspects of physiology simultaneously, and many adverse effects are not always immediately clear. Currently, MV is applied in a rather generic manner; however, the clinicians have recognized the need for accounting for inter-patient variation [ 35 , 36 ]. VALI due to overstretching of lung parenchyma can be minimized by applying lower tidal volumes [ 37 ], but this needs to be achieved without allowing PaCO 2 and pH to rise to dangerous levels (permitted hypercapnea).…”

Section: Discussionmentioning

confidence: 99%

Can computer simulators accurately represent the pathophysiology of individual COPD patients?

Wang

Das

Ali

et al. 2014

ICMx

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BackgroundComputer simulation models could play a key role in developing novel therapeutic strategies for patients with chronic obstructive pulmonary disease (COPD) if they can be shown to accurately represent the pathophysiological characteristics of individual patients.MethodsWe evaluated the capability of a computational simulator to reproduce the heterogeneous effects of COPD on alveolar mechanics as captured in a number of different patient datasets.ResultsOur results show that accurately representing the pathophysiology of individual COPD patients necessitates the use of simulation models with large numbers (up to 200) of compartments for gas exchange. The tuning of such complex simulation models ‘by hand’ to match patient data is not feasible, and thus we present an automated approach based on the use of global optimization algorithms and high-performance computing. Using this approach, we are able to achieve extremely close matches between the simulator and a range of patient data including PaO2, PaCO2, pulmonary deadspace fraction, pulmonary shunt fraction, and ventilation/perfusion (V̇/Q) curves. Using the simulator, we computed combinations of ventilator settings that optimally manage the trade-off between ensuring adequate gas exchange and minimizing the risk of ventilator-associated lung injury for an individual COPD patient.ConclusionsOur results significantly strengthen the credibility of computer simulation models as research tools for the development of novel management protocols in COPD and other pulmonary disease states.Electronic supplementary materialThe online version of this article (doi:10.1186/s40635-014-0023-0) contains supplementary material, which is available to authorized users.

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Lower tidal volumes for everyone: principle or prescription?

Cited by 10 publications

References 15 publications

Overview of current lung imaging in acute respiratory distress syndrome

Overview of current lung imaging in acute respiratory distress syndrome

Lung protective ventilation in patients undergoing major surgery: a systematic review incorporating a Bayesian approach

Can computer simulators accurately represent the pathophysiology of individual COPD patients?

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