Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients
Identifieur interne : 002A78 ( Ncbi/Merge ); précédent : 002A77; suivant : 002A79Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients
Auteurs : Aude Garnero [France] ; David Tuxen ; Gaëlle Corno [France] ; Jacques Durand-Gasselin [France] ; Carol Hodgson ; Jean-Michel Arnal [France, Suisse]Source :
- Critical Care [ 1364-8535 ] ; 2015.
Descripteurs français
- KwdFr :
- MESH :
English descriptors
- KwdEn :
- MESH :
- methods : Positive-Pressure Respiration.
- physiopathology : Lung, Respiratory Distress Syndrome, Adult.
- therapy : Respiratory Distress Syndrome, Adult.
- Aged, Female, Humans, Lung Volume Measurements, Male, Prospective Studies, Time Factors.
Abstract
Lung recruitment maneuvers followed by an individually titrated positive end-expiratory pressure (PEEP) are the key components of the open lung ventilation strategy in acute respiratory distress syndrome (ARDS). The staircase recruitment maneuver is a step-by-step increase in PEEP followed by a decremental PEEP trial. The duration of each step is usually 2 minutes without physiologic rationale.
In this prospective study, we measured the dynamic end-expiratory lung volume changes (ΔEELV) during an increase and decrease in PEEP to determine the optimal duration for each step. PEEP was progressively increased from 5 to 40 cmH2O and then decreased from 40 to 5 cmH2O in steps of 5 cmH2O every 2.5 minutes. The dynamic of ΔEELV was measured by direct spirometry as the difference between inspiratory and expiratory tidal volumes over 2.5 minutes following each increase and decrease in PEEP. ΔEELV was separated between the expected increased volume, calculated as the product of the respiratory system compliance by the change in PEEP, and the additional volume.
Twenty-six early onset moderate or severe ARDS patients were included. Data are expressed as median [25th-75th quartiles]. During the increase in PEEP, the expected increased volume was achieved within 2[2-2] breaths. During the decrease in PEEP, the expected decreased volume was achieved within 1 [1–1] breath, and 95 % of the additional decreased volume was achieved within 8 [2–15] breaths. Completion of volume changes in 99 % of both increase and decrease in PEEP events required 29 breaths.
In early ARDS, most of the ΔEELV occurs within the first minute, and change is completed within 2 minutes, following an increase or decrease in PEEP.
Url:
DOI: 10.1186/s13054-015-1044-0
PubMed: 26383835
PubMed Central: 4574463
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<term>Positive-Pressure Respiration (methods)</term>
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<term>Poumon (physiopathologie)</term>
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<term>Ventilation à pression positive ()</term>
<term>Études prospectives</term>
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<term>Humans</term>
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<term>Mâle</term>
<term>Sujet âgé</term>
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<front><div type="abstract" xml:lang="en"><sec><title>Introduction</title>
<p>Lung recruitment maneuvers followed by an individually titrated positive end-expiratory pressure (PEEP) are the key components of the open lung ventilation strategy in acute respiratory distress syndrome (ARDS). The staircase recruitment maneuver is a step-by-step increase in PEEP followed by a decremental PEEP trial. The duration of each step is usually 2 minutes without physiologic rationale.</p>
</sec>
<sec><title>Methods</title>
<p>In this prospective study, we measured the dynamic end-expiratory lung volume changes (ΔEELV) during an increase and decrease in PEEP to determine the optimal duration for each step. PEEP was progressively increased from 5 to 40 cmH<sub>2</sub>
O and then decreased from 40 to 5 cmH<sub>2</sub>
O in steps of 5 cmH<sub>2</sub>
O every 2.5 minutes. The dynamic of ΔEELV was measured by direct spirometry as the difference between inspiratory and expiratory tidal volumes over 2.5 minutes following each increase and decrease in PEEP. ΔEELV was separated between the expected increased volume, calculated as the product of the respiratory system compliance by the change in PEEP, and the additional volume.</p>
</sec>
<sec><title>Results</title>
<p>Twenty-six early onset moderate or severe ARDS patients were included. Data are expressed as median [25th-75th quartiles]. During the increase in PEEP, the expected increased volume was achieved within 2[2-2] breaths. During the decrease in PEEP, the expected decreased volume was achieved within 1 [1–1] breath, and 95 % of the additional decreased volume was achieved within 8 [2–15] breaths. Completion of volume changes in 99 % of both increase and decrease in PEEP events required 29 breaths.</p>
</sec>
<sec><title>Conclusions</title>
<p>In early ARDS, most of the ΔEELV occurs within the first minute, and change is completed within 2 minutes, following an increase or decrease in PEEP.</p>
</sec>
</div>
</front>
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<author><name sortKey="Garnero, Aude" sort="Garnero, Aude" uniqKey="Garnero A" first="Aude" last="Garnero">Aude Garnero</name>
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<wicri:noCountry code="subfield">VIC 3004 Australia</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Tuxen, David" sort="Tuxen, David" uniqKey="Tuxen D" first="David" last="Tuxen">David Tuxen</name>
<affiliation><nlm:aff id="Aff3">Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, 55 Commercial Road, PO Box 315, Prahan, VIC 3181 Australia</nlm:aff>
<wicri:noCountry code="subfield">VIC 3181 Australia</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Corno, Gaelle" sort="Corno, Gaelle" uniqKey="Corno G" first="Gaëlle" last="Corno">Gaëlle Corno</name>
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</affiliation>
</author>
<author><name sortKey="Durand Gasselin, Jacques" sort="Durand Gasselin, Jacques" uniqKey="Durand Gasselin J" first="Jacques" last="Durand-Gasselin">Jacques Durand-Gasselin</name>
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</author>
<author><name sortKey="Hodgson, Carol" sort="Hodgson, Carol" uniqKey="Hodgson C" first="Carol" last="Hodgson">Carol Hodgson</name>
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<wicri:noCountry code="subfield">VIC 3004 Australia</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Arnal, Jean Michel" sort="Arnal, Jean Michel" uniqKey="Arnal J" first="Jean-Michel" last="Arnal">Jean-Michel Arnal</name>
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<country xml:lang="fr">France</country>
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<wicri:noRegion>83056 Toulon</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff4">Medical Research, Hamilton Medical, 8 Via Crusch, 7402 Bonaduz, Switzerland</nlm:aff>
<country xml:lang="fr">Suisse</country>
<wicri:regionArea>Medical Research, Hamilton Medical, 8 Via Crusch, 7402 Bonaduz</wicri:regionArea>
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<idno type="doi">10.1186/s13054-015-1044-0</idno>
<date when="2015">2015</date>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients</title>
<author><name sortKey="Garnero, Aude" sort="Garnero, Aude" uniqKey="Garnero A" first="Aude" last="Garnero">Aude Garnero</name>
<affiliation wicri:level="3"><nlm:aff id="Aff1">Service de réanimation polyvalente, Hôpital Sainte Musse, 54 Avenue Henri Sainte Claire Deville, 83056 Toulon, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Service de réanimation polyvalente, Hôpital Sainte Musse, 54 Avenue Henri Sainte Claire Deville, 83056 Toulon</wicri:regionArea>
<placeName><region type="region" nuts="2">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Toulon</settlement>
</placeName>
</affiliation>
<affiliation><nlm:aff id="Aff2">Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004 Australia</nlm:aff>
<wicri:noCountry code="subfield">VIC 3004 Australia</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Tuxen, David" sort="Tuxen, David" uniqKey="Tuxen D" first="David" last="Tuxen">David Tuxen</name>
<affiliation><nlm:aff id="Aff3">Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, 55 Commercial Road, PO Box 315, Prahan, VIC 3181 Australia</nlm:aff>
<wicri:noCountry code="subfield">VIC 3181 Australia</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Corno, Gaelle" sort="Corno, Gaelle" uniqKey="Corno G" first="Gaëlle" last="Corno">Gaëlle Corno</name>
<affiliation wicri:level="3"><nlm:aff id="Aff1">Service de réanimation polyvalente, Hôpital Sainte Musse, 54 Avenue Henri Sainte Claire Deville, 83056 Toulon, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Service de réanimation polyvalente, Hôpital Sainte Musse, 54 Avenue Henri Sainte Claire Deville, 83056 Toulon</wicri:regionArea>
<placeName><region type="region" nuts="2">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Toulon</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Durand Gasselin, Jacques" sort="Durand Gasselin, Jacques" uniqKey="Durand Gasselin J" first="Jacques" last="Durand-Gasselin">Jacques Durand-Gasselin</name>
<affiliation wicri:level="3"><nlm:aff id="Aff1">Service de réanimation polyvalente, Hôpital Sainte Musse, 54 Avenue Henri Sainte Claire Deville, 83056 Toulon, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Service de réanimation polyvalente, Hôpital Sainte Musse, 54 Avenue Henri Sainte Claire Deville, 83056 Toulon</wicri:regionArea>
<placeName><region type="region" nuts="2">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Toulon</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Hodgson, Carol" sort="Hodgson, Carol" uniqKey="Hodgson C" first="Carol" last="Hodgson">Carol Hodgson</name>
<affiliation><nlm:aff id="Aff2">Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004 Australia</nlm:aff>
<wicri:noCountry code="subfield">VIC 3004 Australia</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Arnal, Jean Michel" sort="Arnal, Jean Michel" uniqKey="Arnal J" first="Jean-Michel" last="Arnal">Jean-Michel Arnal</name>
<affiliation wicri:level="3"><nlm:aff id="Aff1">Service de réanimation polyvalente, Hôpital Sainte Musse, 54 Avenue Henri Sainte Claire Deville, 83056 Toulon, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Service de réanimation polyvalente, Hôpital Sainte Musse, 54 Avenue Henri Sainte Claire Deville, 83056 Toulon</wicri:regionArea>
<placeName><region type="region" nuts="2">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Toulon</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff4">Medical Research, Hamilton Medical, 8 Via Crusch, 7402 Bonaduz, Switzerland</nlm:aff>
<country xml:lang="fr">Suisse</country>
<wicri:regionArea>Medical Research, Hamilton Medical, 8 Via Crusch, 7402 Bonaduz</wicri:regionArea>
<wicri:noRegion>7402 Bonaduz</wicri:noRegion>
</affiliation>
</author>
</analytic>
<series><title level="j">Critical Care</title>
<idno type="ISSN">1364-8535</idno>
<idno type="eISSN">1466-609X</idno>
<imprint><date when="2015">2015</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec><title>Introduction</title>
<p>Lung recruitment maneuvers followed by an individually titrated positive end-expiratory pressure (PEEP) are the key components of the open lung ventilation strategy in acute respiratory distress syndrome (ARDS). The staircase recruitment maneuver is a step-by-step increase in PEEP followed by a decremental PEEP trial. The duration of each step is usually 2 minutes without physiologic rationale.</p>
</sec>
<sec><title>Methods</title>
<p>In this prospective study, we measured the dynamic end-expiratory lung volume changes (ΔEELV) during an increase and decrease in PEEP to determine the optimal duration for each step. PEEP was progressively increased from 5 to 40 cmH<sub>2</sub>
O and then decreased from 40 to 5 cmH<sub>2</sub>
O in steps of 5 cmH<sub>2</sub>
O every 2.5 minutes. The dynamic of ΔEELV was measured by direct spirometry as the difference between inspiratory and expiratory tidal volumes over 2.5 minutes following each increase and decrease in PEEP. ΔEELV was separated between the expected increased volume, calculated as the product of the respiratory system compliance by the change in PEEP, and the additional volume.</p>
</sec>
<sec><title>Results</title>
<p>Twenty-six early onset moderate or severe ARDS patients were included. Data are expressed as median [25th-75th quartiles]. During the increase in PEEP, the expected increased volume was achieved within 2[2-2] breaths. During the decrease in PEEP, the expected decreased volume was achieved within 1 [1–1] breath, and 95 % of the additional decreased volume was achieved within 8 [2–15] breaths. Completion of volume changes in 99 % of both increase and decrease in PEEP events required 29 breaths.</p>
</sec>
<sec><title>Conclusions</title>
<p>In early ARDS, most of the ΔEELV occurs within the first minute, and change is completed within 2 minutes, following an increase or decrease in PEEP.</p>
</sec>
</div>
</front>
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<author><name sortKey="Arnal, Jean Michel" sort="Arnal, Jean Michel" uniqKey="Arnal J" first="Jean-Michel" last="Arnal">Jean-Michel Arnal</name>
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<placeName><region type="region" nuts="2">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Toulon</settlement>
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<author><name sortKey="Tuxen, David" sort="Tuxen, David" uniqKey="Tuxen D" first="David" last="Tuxen">David Tuxen</name>
<affiliation wicri:level="1"><nlm:affiliation>Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, 55 Commercial Road, PO Box 315, Prahan, VIC, 3181, Australia. dtuxen1@bigpond.com.</nlm:affiliation>
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<author><name sortKey="Corno, Gaelle" sort="Corno, Gaelle" uniqKey="Corno G" first="Gaëlle" last="Corno">Gaëlle Corno</name>
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<author><name sortKey="Durand Gasselin, Jacques" sort="Durand Gasselin, Jacques" uniqKey="Durand Gasselin J" first="Jacques" last="Durand-Gasselin">Jacques Durand-Gasselin</name>
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<author><name sortKey="Hodgson, Carol" sort="Hodgson, Carol" uniqKey="Hodgson C" first="Carol" last="Hodgson">Carol Hodgson</name>
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<author><name sortKey="Arnal, Jean Michel" sort="Arnal, Jean Michel" uniqKey="Arnal J" first="Jean-Michel" last="Arnal">Jean-Michel Arnal</name>
<affiliation wicri:level="1"><nlm:affiliation>Service de réanimation polyvalente, Hôpital Sainte Musse, 54 Avenue Henri Sainte Claire Deville, 83056, Toulon, France. jean-michel@arnal.org.</nlm:affiliation>
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<series><title level="j">Critical care (London, England)</title>
<idno type="eISSN">1466-609X</idno>
<imprint><date when="2015" type="published">2015</date>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term>
<term>Female</term>
<term>Humans</term>
<term>Lung (physiopathology)</term>
<term>Lung Volume Measurements</term>
<term>Male</term>
<term>Positive-Pressure Respiration (methods)</term>
<term>Prospective Studies</term>
<term>Respiratory Distress Syndrome, Adult (physiopathology)</term>
<term>Respiratory Distress Syndrome, Adult (therapy)</term>
<term>Time Factors</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Facteurs temps</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mesure des volumes pulmonaires</term>
<term>Mâle</term>
<term>Poumon (physiopathologie)</term>
<term>Sujet âgé</term>
<term>Syndrome de détresse respiratoire de l'adulte ()</term>
<term>Syndrome de détresse respiratoire de l'adulte (physiopathologie)</term>
<term>Ventilation à pression positive ()</term>
<term>Études prospectives</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Positive-Pressure Respiration</term>
</keywords>
<keywords scheme="MESH" qualifier="physiopathologie" xml:lang="fr"><term>Poumon</term>
<term>Syndrome de détresse respiratoire de l'adulte</term>
</keywords>
<keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Lung</term>
<term>Respiratory Distress Syndrome, Adult</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Respiratory Distress Syndrome, Adult</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Aged</term>
<term>Female</term>
<term>Humans</term>
<term>Lung Volume Measurements</term>
<term>Male</term>
<term>Prospective Studies</term>
<term>Time Factors</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Facteurs temps</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mesure des volumes pulmonaires</term>
<term>Mâle</term>
<term>Sujet âgé</term>
<term>Syndrome de détresse respiratoire de l'adulte</term>
<term>Ventilation à pression positive</term>
<term>Études prospectives</term>
</keywords>
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</teiHeader>
<front><div type="abstract" xml:lang="en">Lung recruitment maneuvers followed by an individually titrated positive end-expiratory pressure (PEEP) are the key components of the open lung ventilation strategy in acute respiratory distress syndrome (ARDS). The staircase recruitment maneuver is a step-by-step increase in PEEP followed by a decremental PEEP trial. The duration of each step is usually 2 minutes without physiologic rationale.</div>
</front>
</TEI>
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