Sigh Improves Gas Exchange and Lung Volume in Patients with Acute Respiratory Distress Syndrome Undergoing Pressure Support Ventilation

Patroniti, Nicolò; Foti, Giuseppe; Cortinovis, Barbara; Maggioni, Elena; Bigatello, Luca M.; Cereda, Maurizio; Pesenti, Antonio

doi:10.1097/00000542-200204000-00004

Cited by 112 publications

(83 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several studies have evaluated the effect of sighs. [38][39][40][41][42] In the most recent of these, Mauri et al 42 examined the effect of adding a sigh to pressure-support ventilation in 20 critically ill subjects with a P aO 2 /F IO 2 Ͻ300. They used biphasic positive airway pressure at 35 cm H 2 O for 3-4 s at rates of 2 sighs/min, 1 sigh/min, and 1 sigh/2 min.…”

Section: Types Of Recruitment Maneuversmentioning

confidence: 99%

Recruitment Maneuvers and PEEP Titration

2015

View full text Add to dashboard Cite

The injurious effects of alveolar overdistention are well accepted, and there is little debate regarding the importance of pressure and volume limitation during mechanical ventilation. The role of recruitment maneuvers is more controversial. Alveolar recruitment is desirable if it can be achieved, but the potential for recruitment is variable among patients with ARDS. A stepwise recruitment maneuver, similar to an incremental PEEP titration, is favored over sustained inflation recruitment maneuvers. Many approaches to PEEP titration have been proposed, and the best method to choose the most appropriate level for an individual patient is unclear. A PEEP level should be selected that balances alveolar recruitment against overdistention. The easiest approach to select PEEP might be according to the severity of the disease: 5-10 cm H 2 O PEEP in mild ARDS, 10 -15 cm H 2 O PEEP in moderate ARDS, and 15-20 cm H 2 O PEEP in severe ARDS. Recruitment maneuvers and PEEP should be used within the context of lung protection and not just as a means of improving oxygenation.

show abstract

Section: Types Of Recruitment Maneuversmentioning

confidence: 99%

Recruitment Maneuvers and PEEP Titration

2015

View full text Add to dashboard Cite

show abstract

“…In all studies using single or repeated recruitment manoeuvres that showed an increase in P a O 2 the effect was immediate but usually only short lasting [57][58][59][60][61][62][63][64][65][66][67][68]. Only one study on patients receiving mechanical ventilation for less than 72 h showed a prolonged oxygen increase of 60% in 4 h after a single sustained inflation [69].…”

Section: Human Studiesmentioning

confidence: 99%

Lung recruitment during mechanical positive pressure ventilation in the PICU: what can be learned from the literature?

Halbertsma¹,

Hoeven

2005

Anaesthesia

View full text Add to dashboard Cite

Summary A literature review was conducted to assess the evidence for recruitment manoeuvres used in conventional mechanical positive pressure ventilation. A total of 61 studies on recruitment manoeuvres were identified: 13 experimental, 31 ICU, 6 PICU and 12 anaesthesia studies. Recruitment appears to be a continuous process during inspiration and expiration and is determined by peak inspiratory pressure (PIP) and positive end expiratory pressure (PEEP). Single or repeated recruitment manoeuvres may result in a statistically significant increase in oxygenation; however, this is short lasting and clinically irrelevant, especially in late ARDS and pneumonia. Temporary PIP elevation may be effective but only after PEEP loss (for example disconnection and tracheal suctioning). Continuous PEEP elevation and prone positioning can increase Pao2 significantly. Adverse haemodynamic or barotrauma effects are reported in various studies. No data exist on the effect of recruitment manoeuvres on mortality, morbidity, length of stay or duration of mechanical ventilation. Although recruitment manoeuvres can improve oxygenation, they can potentially increase lung injury, which eventually determines outcome. Based on the presently available literature, prone position and sufficient PEEP as part of a lung protective ventilation strategy seem to be the safest and most effective recruitment manoeuvres. As paediatric physiology is essentially different from adult, paediatric studies are needed to determine the role of recruitment manoeuvres in the PICU.

show abstract

“…There is no doubt that initial lung recruitment rapidly improves oxygenation, which will only be maintained when using high PEEP levels (25)(26)(27)(28)(29). These observations were also made in ARDS patients with increased functional residual capacity and end-expiratory lung volume after the utilization of lung inflation or with sighs associated with PEEP (16,30,31). It is known that low PEEP in ARDS patients cannot improve oxygenation (1,(6)(7)(8)(9).…”

Section: Discussionmentioning

confidence: 99%

Variable positive end-expiratory pressure can maintain oxygenation in experimental acute respiratory distress syndrome induced by oleic acid in dogs

Lanza

Damasceno

Leme

et al. 2009

Braz J Med Biol Res

View full text Add to dashboard Cite

The use of positive end-expiratory pressure (PEEP) or lung recruitment maneuvers (RM) to improve oxygenation in acute respiratory distress syndrome (ARDS) is used but it may reduce cardiac output (CO). Intermittent PEEP may avoid these complications. Our objective was to determine if variable PEEP compared with constant PEEP is capable of maintaining arterial oxygenation and minimizing hemodynamic alterations with or without RM. Eighteen dogs with ARDS induced by oleic acid were randomized into three equal groups: group 1, low variable PEEP; group 2, high variable PEEP, and group 3, RM + high variable PEEP. All groups were submitted to constant PEEP, followed by variable PEEP (PEEP was increased from 5 to 10 cmH2O in group 1, and from 5 to 18 cmH2O in the other two groups). PaO2 was higher in group 3 (356.2 ± 65.4 mmHg) than in group 1 (92.7 ± 29.7 mmHg) and group 2 (228.5 ± 72.4 mmHg), P < 0.05. PaO2 was maintained during variable PEEP except in group 2 (318.5 ± 82.9 at constant PEEP to 228.5 ± 72.4 at variable PEEP). There was a reduction in CO in group 3 after RM (3.9 ± 1.1 before to 2.7 ± 0.5 L·min-1·(m2)-1 after; P < 0.05), but there was not any difference between constant and variable PEEP periods (2.7 ± 0.5 and 2.4 ± 0.7 L·min-1·(m2)-1; P > 0.05. Variable PEEP is able to maintain PaO2 when performed in combination with RM in dogs with ARDS. After RM, CO was reduced and there was no relevant difference between the variable and constant PEEP periods

show abstract

Sigh Improves Gas Exchange and Lung Volume in Patients with Acute Respiratory Distress Syndrome Undergoing Pressure Support Ventilation

Abstract: The addition of 1 sigh per minute during PSV in patients with early ARDS improved gas exchange and lung volume and decreased the respiratory drive.

Cited by 112 publications

References 28 publications

Recruitment Maneuvers and PEEP Titration

Recruitment Maneuvers and PEEP Titration

Lung recruitment during mechanical positive pressure ventilation in the PICU: what can be learned from the literature?

Variable positive end-expiratory pressure can maintain oxygenation in experimental acute respiratory distress syndrome induced by oleic acid in dogs

Contact Info

Product

Resources

About