Ventilation and Perfusion of Each Lung during Differential Ventilation with Selective PEEP

Hedenstierna, Göran; Baehrendtz, S.; Klingstedt, C.; Santesson, J.; Söderborg, B.; Dahlborn, Mats; Bindslev, L.

doi:10.1097/00000542-198410000-00003

Cited by 78 publications

(28 citation statements)

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“…It has been observed that the blood flow in these capillaries occurs despite alveolar pressures being, at times, in excess of the capillary blood pressure (Lloyd and Wright, 1960;Thomas et al, 1961). Additional support for this suggestion derives from studies implying that capillary resistance increases when one removes the influence of the alveolar surface tension (Goetz et al, 1999;Hedenstierna et al, 1984), thus suggesting that the alveolar surface tension promotes capillary blood flow. Studies in which vascular resistance measurements were coupled with direct visualization of this microvasculature indicate that the pulmonary arterial and the venous vascular resistance increase with an increase in alveolar surface tension (by reducing surfactant), while the capillary resistance decreases with a subsequent increase in the capillary distension and recruitment (Nieman et al, 1988).…”

Section: Surface Tension Effects On Pulmonary Hemodynamicsmentioning

confidence: 99%

“…Pulmonary perfusion is decreased to the nondependent lung and increased to the dependent lung in the lateral decubitus posture (LLD) (Mure et al, 1998). In addition, the use of unilateral PEEP to the dependent lung has been proposed to be superior to the conventional bilateral PEEP in producing a more even ventilation distribution and improving gas exchange (Hedenstierna et al, 1984).…”

Section: Positive Pressure Inflationmentioning

confidence: 99%

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Pulmonary Hemodynamics

Aggarwal¹,

Groß²,

Porcelli³

et al. 2015

Comparative Biology of the Normal Lung

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Section: Surface Tension Effects On Pulmonary Hemodynamicsmentioning

confidence: 99%

Section: Positive Pressure Inflationmentioning

confidence: 99%

Pulmonary Hemodynamics

Aggarwal¹,

Groß²,

Porcelli³

et al. 2015

Comparative Biology of the Normal Lung

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“…Bei nicht selektierten Patienten war dieser Effekt allerdings nicht nachweisbar; die Oxy genierung verschlechterte sich im Mittel sogar [92]. Zwar reduziert ein PEEP von 10 mbar die Größe der Atelektasen, gleich zeitig kann die Oxygenierung durch Um verteilung der Perfusion (von belüfteten Lungenbereichen in nicht oder schlecht belüftete Lungenbereiche) und Zunah me der Totraumventilation beeinträchtigt werden [93].…”

Section: Positiv-endexspiratorischer Druckunclassified

Protective ventilation therapy

2010

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General anesthesia and mechanical ventilation affect gas exchange, ventilation and pulmonary perfusion and there is an increasing body of evidence that mechanical ventilation itself promotes lung injury. Lung protective mechanical ventilation in patients suffering from acute lung injury or acute respiratory distress syndrome by means of reduced tidal volumes and limited plateau pressures has been shown to result in reduction of systemic inflammatory mediators, increased ventilator-free days and reduction in mortality. Experimental studies suggest that mechanical ventilation of uninjured lungs may also induce lung damage; however, the clinical relevance remains unknown. Human prospective studies comparing mechanical ventilation strategies during general anesthesia have shown inconsistent results with respect to inflammatory mediators. There is a lack of clinical evidence that lung protective ventilation strategies as used in patients with lung injury may improve clinical outcome of patients with uninjured lungs. The question of which ventilatory strategy will best protect normal human lungs remains unanswered.

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“…Positive end expiratory pressure (PEEP) increases dependent lung ventilation in anaesthetised subjects, so the distribution of ventilation is more similar to that in the awake state [20]. Thus, restoration of overall FRC toward or beyond the awake level returns gas distribution toward the awake pattern.…”

Section: Distribution Of Ventilation and Perfusionmentioning

confidence: 99%

Field Intensive Care - Weaning and Extubation

et al. 2010

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Anaesthesia causes an impairment of pulmonary function, irrespective of whether the patient is breathing spontaneously, or is being mechanically ventilated. Impaired oxygenation of blood occurs in most subjects who are anaesthetised [6]. Lung function remains impaired postoperatively, and clinically significant pulmonary complications can be seen in 1% to 2% after minor surgery, and in up to 20% after upper abdominal and thoracic surgery [7]. AbstractInjury following ballistic trauma is the most prevalent indication for providing organ system support within an ICU in the field. Following damage control surgery, postoperative ventilatory support may be required, but multiple factors may influence the indications for and duration of invasive mechanical ventilation. Ballistic trauma and surgery may trigger the Systemic Inflammatory Response Syndrome (SIRS) and are important causative factors in the development of Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS). However, their pathophysiological effect on the respiratory system is unpredictable and variable. Invasive mechanical ventilation is associated with numerous complications and the return to spontaneous ventilation has many physiological benefits. Following trauma, shorter periods of ICU sedation-amnesia and a protocol for early weaning and extubation, may minimize complications and have a beneficial effect on their psychological recovery. In the presence of stable respiratory function, appropriate analgesia and favourable operational and transfer criteria, we believe that the prompt restoration of spontaneous ventilation and early tracheal extubation should be a clinical objective for casualties within the field ICU.

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Ventilation and Perfusion of Each Lung during Differential Ventilation with Selective PEEP

Cited by 78 publications

References 0 publications

Pulmonary Hemodynamics

Pulmonary Hemodynamics

Protective ventilation therapy

Field Intensive Care - Weaning and Extubation

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