Histologic aspects of pulmonary barotrauma in critically ill patients with acute respiratory failure
Identifieur interne : 000217 ( Istex/Corpus ); précédent : 000216; suivant : 000218Histologic aspects of pulmonary barotrauma in critically ill patients with acute respiratory failure
Auteurs : J. J. Rouby ; T. Lherm ; E. Martin De Lassale ; P. Poète ; L. Bodin ; J. F. Finet ; P. Callard ; P. ViarsSource :
- Intensive Care Medicine [ 0342-4642 ] ; 1993-07-01.
Abstract
Abstract: Objective: To describe histologically pulmonary barotrauma in mechanically ventilated patients with severe acute respiratory failure. Design: Assessment of histologic pulmonary barotrauma. Setting: A 14-bed surgical intensive care unit (SICU). Patients: The lungs of 30 young critically ill patients (mean age 34±10 years) were histologically examined in the immediate post-mortem period. None of them were suspected of pre-existing emphysema. Measurements and results: Clinical events and ventilatory settings used during mechanical ventilation were compared with lung histology. Airspace enlargement, defined as the presence of either alveolar overdistension in aerated lung areas or intraparenchymal pseudocysts in nonaerated lung areas, was found in 26 of the 30 lungs examined (86%). Patients with severe airspace enlargement (2.6–40 mm internal diameter) had a significantly greater incidence of pneumothorax (8 versus 2,p<0.05), were ventilated using higher peak airway pressures (56±18 cmH2O versus 44±10 cmH2O,p<0.05) and tidal volumes (12±3 ml/kg, versus 9±2ml/kg,p<0.05) were exposed significantly longer to toxic levels of oxygen (8.6±9.4 days versus 1.9±2 days at FIO2>0.6,p<0.05) and lost more weight (6.3±9.2 kg versus 0.75±5.8 kg,p<0.05) than patients with mild airspace enlargement (1–2.5 mm internal diameter). Conclusion: Underlying histologic lesions responsible for clinical lung barotrauma consist of pleural cysts, bronchiolar dilatation, alveolar overdistension and intraparenchymal pseudocysts. Mechanical ventilation appears to be an aggravating factor, particularly when high peak airway pressures and large tidal volumes are delivered by the ventilator.
Url:
DOI: 10.1007/BF01724877
Links to Exploration step
ISTEX:C53D584806661D171CD3F0F63F8450C95A67741FLe document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Histologic aspects of pulmonary barotrauma in critically ill patients with acute respiratory failure</title><author><name sortKey="Rouby, J J" sort="Rouby, J J" uniqKey="Rouby J" first="J. J." last="Rouby">J. J. Rouby</name><affiliation><mods:affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Lherm, T" sort="Lherm, T" uniqKey="Lherm T" first="T." last="Lherm">T. Lherm</name><affiliation><mods:affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Martin De Lassale, E" sort="Martin De Lassale, E" uniqKey="Martin De Lassale E" first="E." last="Martin De Lassale">E. Martin De Lassale</name><affiliation><mods:affiliation>Department of Pathology, Hôpital de la Pitié-Salpêtrière, Université Paris VI, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Poete, P" sort="Poete, P" uniqKey="Poete P" first="P." last="Poète">P. Poète</name><affiliation><mods:affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Bodin, L" sort="Bodin, L" uniqKey="Bodin L" first="L." last="Bodin">L. Bodin</name><affiliation><mods:affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Finet, J F" sort="Finet, J F" uniqKey="Finet J" first="J. F." last="Finet">J. F. Finet</name><affiliation><mods:affiliation>Department of Pathology, Hôpital de la Pitié-Salpêtrière, Université Paris VI, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Callard, P" sort="Callard, P" uniqKey="Callard P" first="P." last="Callard">P. Callard</name><affiliation><mods:affiliation>Department of Pathology, Hôpital Jean Verdier, Université Paris XIII, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Viars, P" sort="Viars, P" uniqKey="Viars P" first="P." last="Viars">P. Viars</name><affiliation><mods:affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:C53D584806661D171CD3F0F63F8450C95A67741F</idno><date when="1993" year="1993">1993</date><idno type="doi">10.1007/BF01724877</idno><idno type="url">https://api.istex.fr/document/C53D584806661D171CD3F0F63F8450C95A67741F/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000217</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000217</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Histologic aspects of pulmonary barotrauma in critically ill patients with acute respiratory failure</title><author><name sortKey="Rouby, J J" sort="Rouby, J J" uniqKey="Rouby J" first="J. J." last="Rouby">J. J. Rouby</name><affiliation><mods:affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Lherm, T" sort="Lherm, T" uniqKey="Lherm T" first="T." last="Lherm">T. Lherm</name><affiliation><mods:affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Martin De Lassale, E" sort="Martin De Lassale, E" uniqKey="Martin De Lassale E" first="E." last="Martin De Lassale">E. Martin De Lassale</name><affiliation><mods:affiliation>Department of Pathology, Hôpital de la Pitié-Salpêtrière, Université Paris VI, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Poete, P" sort="Poete, P" uniqKey="Poete P" first="P." last="Poète">P. Poète</name><affiliation><mods:affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Bodin, L" sort="Bodin, L" uniqKey="Bodin L" first="L." last="Bodin">L. Bodin</name><affiliation><mods:affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Finet, J F" sort="Finet, J F" uniqKey="Finet J" first="J. F." last="Finet">J. F. Finet</name><affiliation><mods:affiliation>Department of Pathology, Hôpital de la Pitié-Salpêtrière, Université Paris VI, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Callard, P" sort="Callard, P" uniqKey="Callard P" first="P." last="Callard">P. Callard</name><affiliation><mods:affiliation>Department of Pathology, Hôpital Jean Verdier, Université Paris XIII, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Viars, P" sort="Viars, P" uniqKey="Viars P" first="P." last="Viars">P. Viars</name><affiliation><mods:affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Intensive Care Medicine</title><title level="j" type="abbrev">Intensive Care Med</title><idno type="ISSN">0342-4642</idno><idno type="eISSN">1432-1238</idno><imprint><publisher>Springer-Verlag</publisher><pubPlace>Berlin/Heidelberg</pubPlace><date type="published" when="1993-07-01">1993-07-01</date><biblScope unit="volume">19</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="383">383</biblScope><biblScope unit="page" to="389">389</biblScope></imprint><idno type="ISSN">0342-4642</idno></series><idno type="istex">C53D584806661D171CD3F0F63F8450C95A67741F</idno><idno type="DOI">10.1007/BF01724877</idno><idno type="ArticleID">Art6</idno><idno type="ArticleID">BF01724877</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0342-4642</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Abstract: Objective: To describe histologically pulmonary barotrauma in mechanically ventilated patients with severe acute respiratory failure. Design: Assessment of histologic pulmonary barotrauma. Setting: A 14-bed surgical intensive care unit (SICU). Patients: The lungs of 30 young critically ill patients (mean age 34±10 years) were histologically examined in the immediate post-mortem period. None of them were suspected of pre-existing emphysema. Measurements and results: Clinical events and ventilatory settings used during mechanical ventilation were compared with lung histology. Airspace enlargement, defined as the presence of either alveolar overdistension in aerated lung areas or intraparenchymal pseudocysts in nonaerated lung areas, was found in 26 of the 30 lungs examined (86%). Patients with severe airspace enlargement (2.6–40 mm internal diameter) had a significantly greater incidence of pneumothorax (8 versus 2,p<0.05), were ventilated using higher peak airway pressures (56±18 cmH2O versus 44±10 cmH2O,p<0.05) and tidal volumes (12±3 ml/kg, versus 9±2ml/kg,p<0.05) were exposed significantly longer to toxic levels of oxygen (8.6±9.4 days versus 1.9±2 days at FIO2>0.6,p<0.05) and lost more weight (6.3±9.2 kg versus 0.75±5.8 kg,p<0.05) than patients with mild airspace enlargement (1–2.5 mm internal diameter). Conclusion: Underlying histologic lesions responsible for clinical lung barotrauma consist of pleural cysts, bronchiolar dilatation, alveolar overdistension and intraparenchymal pseudocysts. Mechanical ventilation appears to be an aggravating factor, particularly when high peak airway pressures and large tidal volumes are delivered by the ventilator.</div></front></TEI><istex><corpusName>springer</corpusName><author><json:item><name>Dr. J. J. Rouby</name><affiliations><json:string>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</json:string></affiliations></json:item><json:item><name>T. Lherm</name><affiliations><json:string>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</json:string></affiliations></json:item><json:item><name>E. Martin de Lassale</name><affiliations><json:string>Department of Pathology, Hôpital de la Pitié-Salpêtrière, Université Paris VI, Paris, France</json:string></affiliations></json:item><json:item><name>P. Poète</name><affiliations><json:string>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</json:string></affiliations></json:item><json:item><name>L. Bodin</name><affiliations><json:string>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</json:string></affiliations></json:item><json:item><name>J. F. Finet</name><affiliations><json:string>Department of Pathology, Hôpital de la Pitié-Salpêtrière, Université Paris VI, Paris, France</json:string></affiliations></json:item><json:item><name>P. Callard</name><affiliations><json:string>Department of Pathology, Hôpital Jean Verdier, Université Paris XIII, Paris, France</json:string></affiliations></json:item><json:item><name>P. Viars</name><affiliations><json:string>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</json:string></affiliations></json:item></author><articleId><json:string>Art6</json:string><json:string>BF01724877</json:string></articleId><language><json:string>eng</json:string></language><abstract>Abstract: Objective: To describe histologically pulmonary barotrauma in mechanically ventilated patients with severe acute respiratory failure. Design: Assessment of histologic pulmonary barotrauma. Setting: A 14-bed surgical intensive care unit (SICU). Patients: The lungs of 30 young critically ill patients (mean age 34±10 years) were histologically examined in the immediate post-mortem period. None of them were suspected of pre-existing emphysema. Measurements and results: Clinical events and ventilatory settings used during mechanical ventilation were compared with lung histology. Airspace enlargement, defined as the presence of either alveolar overdistension in aerated lung areas or intraparenchymal pseudocysts in nonaerated lung areas, was found in 26 of the 30 lungs examined (86%). Patients with severe airspace enlargement (2.6–40 mm internal diameter) had a significantly greater incidence of pneumothorax (8 versus 2,p>0.05), were ventilated using higher peak airway pressures (56±18 cmH2O versus 44±10 cmH2O,p>0.05) and tidal volumes (12±3 ml/kg, versus 9±2ml/kg,p>0.05) were exposed significantly longer to toxic levels of oxygen (8.6±9.4 days versus 1.9±2 days at FIO2>0.6,p>0.05) and lost more weight (6.3±9.2 kg versus 0.75±5.8 kg,p>0.05) than patients with mild airspace enlargement (1–2.5 mm internal diameter). Conclusion: Underlying histologic lesions responsible for clinical lung barotrauma consist of pleural cysts, bronchiolar dilatation, alveolar overdistension and intraparenchymal pseudocysts. Mechanical ventilation appears to be an aggravating factor, particularly when high peak airway pressures and large tidal volumes are delivered by the ventilator.</abstract><qualityIndicators><score>7.25</score><pdfVersion>1.3</pdfVersion><pdfPageSize>597.28 x 785 pts</pdfPageSize><refBibsNative>false</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>1691</abstractCharCount><pdfWordCount>4574</pdfWordCount><pdfCharCount>29547</pdfCharCount><pdfPageCount>7</pdfPageCount><abstractWordCount>223</abstractWordCount></qualityIndicators><title>Histologic aspects of pulmonary barotrauma in critically ill patients with acute respiratory failure</title><genre><json:string>research-article</json:string></genre><host><volume>19</volume><pages><last>389</last><first>383</first></pages><issn><json:string>0342-4642</json:string></issn><issue>7</issue><subject><json:item><value>Anesthesiology</value></json:item><json:item><value>Emergency Medicine</value></json:item><json:item><value>Intensive / Critical Care Medicine</value></json:item><json:item><value>Pneumology/Respiratory System</value></json:item><json:item><value>Pain Medicine</value></json:item><json:item><value>Pediatrics</value></json:item></subject><journalId><json:string>134</json:string></journalId><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1432-1238</json:string></eissn><title>Intensive Care Medicine</title><publicationDate>1993</publicationDate><copyrightDate>1993</copyrightDate></host><publicationDate>1993</publicationDate><copyrightDate>1993</copyrightDate><doi><json:string>10.1007/BF01724877</json:string></doi><id>C53D584806661D171CD3F0F63F8450C95A67741F</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/C53D584806661D171CD3F0F63F8450C95A67741F/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/C53D584806661D171CD3F0F63F8450C95A67741F/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/C53D584806661D171CD3F0F63F8450C95A67741F/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Histologic aspects of pulmonary barotrauma in critically ill patients with acute respiratory failure</title><respStmt xml:id="ISTEX-API" resp="Références bibliographiques récupérées via GROBID" name="ISTEX-API (INIST-CNRS)"></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Springer-Verlag</publisher><pubPlace>Berlin/Heidelberg</pubPlace><availability><p>SPRINGER</p></availability><date>1993-01-22</date></publicationStmt><notesStmt><note>Originals/Rapid Publication</note><note>Presented in part at the 32ème Congrès de la Société Française d'Anesthésie-Réanimation, Septembre 1990, Paris, France</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Histologic aspects of pulmonary barotrauma in critically ill patients with acute respiratory failure</title><author corresp="yes"><persName><forename type="first">J.</forename><surname>Rouby</surname></persName><roleName type="degree">Dr.</roleName><affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</affiliation></author><author><persName><forename type="first">T.</forename><surname>Lherm</surname></persName><affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</affiliation></author><author><persName><forename type="first">E.</forename><surname>Martin de Lassale</surname></persName><affiliation>Department of Pathology, Hôpital de la Pitié-Salpêtrière, Université Paris VI, Paris, France</affiliation></author><author><persName><forename type="first">P.</forename><surname>Poète</surname></persName><affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</affiliation></author><author><persName><forename type="first">L.</forename><surname>Bodin</surname></persName><affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</affiliation></author><author><persName><forename type="first">J.</forename><surname>Finet</surname></persName><affiliation>Department of Pathology, Hôpital de la Pitié-Salpêtrière, Université Paris VI, Paris, France</affiliation></author><author><persName><forename type="first">P.</forename><surname>Callard</surname></persName><affiliation>Department of Pathology, Hôpital Jean Verdier, Université Paris XIII, Paris, France</affiliation></author><author><persName><forename type="first">P.</forename><surname>Viars</surname></persName><affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</affiliation></author></analytic><monogr><title level="j">Intensive Care Medicine</title><title level="j" type="abbrev">Intensive Care Med</title><idno type="JournalID">134</idno><idno type="pISSN">0342-4642</idno><idno type="eISSN">1432-1238</idno><idno type="IssueArticleCount">18</idno><idno type="VolumeIssueCount">8</idno><imprint><publisher>Springer-Verlag</publisher><pubPlace>Berlin/Heidelberg</pubPlace><date type="published" when="1993-07-01"></date><biblScope unit="volume">19</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="383">383</biblScope><biblScope unit="page" to="389">389</biblScope></imprint></monogr><idno type="istex">C53D584806661D171CD3F0F63F8450C95A67741F</idno><idno type="DOI">10.1007/BF01724877</idno><idno type="ArticleID">Art6</idno><idno type="ArticleID">BF01724877</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1993-01-22</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Abstract: Objective: To describe histologically pulmonary barotrauma in mechanically ventilated patients with severe acute respiratory failure. Design: Assessment of histologic pulmonary barotrauma. Setting: A 14-bed surgical intensive care unit (SICU). Patients: The lungs of 30 young critically ill patients (mean age 34±10 years) were histologically examined in the immediate post-mortem period. None of them were suspected of pre-existing emphysema. Measurements and results: Clinical events and ventilatory settings used during mechanical ventilation were compared with lung histology. Airspace enlargement, defined as the presence of either alveolar overdistension in aerated lung areas or intraparenchymal pseudocysts in nonaerated lung areas, was found in 26 of the 30 lungs examined (86%). Patients with severe airspace enlargement (2.6–40 mm internal diameter) had a significantly greater incidence of pneumothorax (8 versus 2,p<0.05), were ventilated using higher peak airway pressures (56±18 cmH2O versus 44±10 cmH2O,p<0.05) and tidal volumes (12±3 ml/kg, versus 9±2ml/kg,p<0.05) were exposed significantly longer to toxic levels of oxygen (8.6±9.4 days versus 1.9±2 days at FIO2>0.6,p<0.05) and lost more weight (6.3±9.2 kg versus 0.75±5.8 kg,p<0.05) than patients with mild airspace enlargement (1–2.5 mm internal diameter). Conclusion: Underlying histologic lesions responsible for clinical lung barotrauma consist of pleural cysts, bronchiolar dilatation, alveolar overdistension and intraparenchymal pseudocysts. Mechanical ventilation appears to be an aggravating factor, particularly when high peak airway pressures and large tidal volumes are delivered by the ventilator.</p></abstract><textClass><keywords scheme="Journal Subject"><list><head>Medicine & Public Health</head><item><term>Anesthesiology</term></item><item><term>Emergency Medicine</term></item><item><term>Intensive / Critical Care Medicine</term></item><item><term>Pneumology/Respiratory System</term></item><item><term>Pain Medicine</term></item><item><term>Pediatrics</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="1993-01-22">Created</change><change when="1993-07-01">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2016-3-2">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/C53D584806661D171CD3F0F63F8450C95A67741F/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Springer, Publisher found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//Springer-Verlag//DTD A++ V2.4//EN" URI="http://devel.springer.de/A++/V2.4/DTD/A++V2.4.dtd" name="istex:docType"></istex:docType><istex:document><Publisher><PublisherInfo><PublisherName>Springer-Verlag</PublisherName><PublisherLocation>Berlin/Heidelberg</PublisherLocation></PublisherInfo><Journal><JournalInfo JournalProductType="ArchiveJournal" NumberingStyle="Unnumbered"><JournalID>134</JournalID><JournalPrintISSN>0342-4642</JournalPrintISSN><JournalElectronicISSN>1432-1238</JournalElectronicISSN><JournalTitle>Intensive Care Medicine</JournalTitle><JournalAbbreviatedTitle>Intensive Care Med</JournalAbbreviatedTitle><JournalSubjectGroup><JournalSubject Type="Primary">Medicine & Public Health</JournalSubject><JournalSubject Type="Secondary">Anesthesiology</JournalSubject><JournalSubject Type="Secondary">Emergency Medicine</JournalSubject><JournalSubject Type="Secondary">Intensive / Critical Care Medicine</JournalSubject><JournalSubject Type="Secondary">Pneumology/Respiratory System</JournalSubject><JournalSubject Type="Secondary">Pain Medicine</JournalSubject><JournalSubject Type="Secondary">Pediatrics</JournalSubject></JournalSubjectGroup></JournalInfo><Volume><VolumeInfo VolumeType="Regular" TocLevels="0"><VolumeIDStart>19</VolumeIDStart><VolumeIDEnd>19</VolumeIDEnd><VolumeIssueCount>8</VolumeIssueCount></VolumeInfo><Issue IssueType="Regular"><IssueInfo TocLevels="0"><IssueIDStart>7</IssueIDStart><IssueIDEnd>7</IssueIDEnd><IssueArticleCount>18</IssueArticleCount><IssueHistory><CoverDate><DateString>1993</DateString><Year>1993</Year><Month>7</Month></CoverDate></IssueHistory><IssueCopyright><CopyrightHolderName>Springer-Verlag</CopyrightHolderName><CopyrightYear>1993</CopyrightYear></IssueCopyright></IssueInfo><Article ID="Art6"><ArticleInfo Language="En" ArticleType="OriginalPaper" NumberingStyle="Unnumbered" TocLevels="0" ContainsESM="No"><ArticleID>BF01724877</ArticleID><ArticleDOI>10.1007/BF01724877</ArticleDOI><ArticleSequenceNumber>6</ArticleSequenceNumber><ArticleTitle Language="En">Histologic aspects of pulmonary barotrauma in critically ill patients with acute respiratory failure</ArticleTitle><ArticleCategory>Originals</ArticleCategory><ArticleSubCategory>Rapid Publication</ArticleSubCategory><ArticleFirstPage>383</ArticleFirstPage><ArticleLastPage>389</ArticleLastPage><ArticleHistory><RegistrationDate><Year>2005</Year><Month>4</Month><Day>30</Day></RegistrationDate><Received><Year>1993</Year><Month>1</Month><Day>22</Day></Received><Accepted><Year>1993</Year><Month>6</Month><Day>2</Day></Accepted></ArticleHistory><ArticleCopyright><CopyrightHolderName>Springer-Verlag</CopyrightHolderName><CopyrightYear>1993</CopyrightYear></ArticleCopyright><ArticleGrants Type="Regular"><MetadataGrant Grant="OpenAccess"></MetadataGrant><AbstractGrant Grant="OpenAccess"></AbstractGrant><BodyPDFGrant Grant="Restricted"></BodyPDFGrant><BodyHTMLGrant Grant="Restricted"></BodyHTMLGrant><BibliographyGrant Grant="Restricted"></BibliographyGrant><ESMGrant Grant="Restricted"></ESMGrant></ArticleGrants><ArticleContext><JournalID>134</JournalID><VolumeIDStart>19</VolumeIDStart><VolumeIDEnd>19</VolumeIDEnd><IssueIDStart>7</IssueIDStart><IssueIDEnd>7</IssueIDEnd></ArticleContext></ArticleInfo><ArticleHeader><AuthorGroup><Author AffiliationIDS="Aff1" CorrespondingAffiliationID="Aff1"><AuthorName DisplayOrder="Western"><Prefix>Dr.</Prefix><GivenName>J.</GivenName><GivenName>J.</GivenName><FamilyName>Rouby</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff1"><AuthorName DisplayOrder="Western"><GivenName>T.</GivenName><FamilyName>Lherm</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff2"><AuthorName DisplayOrder="Western"><GivenName>E.</GivenName><FamilyName>Martin de Lassale</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff1"><AuthorName DisplayOrder="Western"><GivenName>P.</GivenName><FamilyName>Poète</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff1"><AuthorName DisplayOrder="Western"><GivenName>L.</GivenName><FamilyName>Bodin</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff2"><AuthorName DisplayOrder="Western"><GivenName>J.</GivenName><GivenName>F.</GivenName><FamilyName>Finet</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff3"><AuthorName DisplayOrder="Western"><GivenName>P.</GivenName><FamilyName>Callard</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff1"><AuthorName DisplayOrder="Western"><GivenName>P.</GivenName><FamilyName>Viars</FamilyName></AuthorName></Author><Affiliation ID="Aff1"><OrgDivision>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière</OrgDivision><OrgName>Université Paris VI</OrgName><OrgAddress><Street>83 boulevard de l'Hôpital</Street><Postcode>F-75651</Postcode><City>Paris</City><Country>France</Country></OrgAddress></Affiliation><Affiliation ID="Aff2"><OrgDivision>Department of Pathology, Hôpital de la Pitié-Salpêtrière</OrgDivision><OrgName>Université Paris VI</OrgName><OrgAddress><City>Paris</City><Country>France</Country></OrgAddress></Affiliation><Affiliation ID="Aff3"><OrgDivision>Department of Pathology, Hôpital Jean Verdier</OrgDivision><OrgName>Université Paris XIII</OrgName><OrgAddress><City>Paris</City><Country>France</Country></OrgAddress></Affiliation></AuthorGroup><Abstract ID="Abs1" Language="En"><Heading>Abstract</Heading><AbstractSection ID="Asec1"><Heading>Objective</Heading><Para>To describe histologically pulmonary barotrauma in mechanically ventilated patients with severe acute respiratory failure.</Para></AbstractSection><AbstractSection ID="Asec2"><Heading>Design</Heading><Para>Assessment of histologic pulmonary barotrauma.</Para></AbstractSection><AbstractSection ID="Asec3"><Heading>Setting</Heading><Para>A 14-bed surgical intensive care unit (SICU).</Para></AbstractSection><AbstractSection ID="Asec4"><Heading>Patients</Heading><Para>The lungs of 30 young critically ill patients (mean age 34±10 years) were histologically examined in the immediate post-mortem period. None of them were suspected of pre-existing emphysema.</Para></AbstractSection><AbstractSection ID="Asec5"><Heading>Measurements and results</Heading><Para>Clinical events and ventilatory settings used during mechanical ventilation were compared with lung histology. Airspace enlargement, defined as the presence of either alveolar overdistension in aerated lung areas or intraparenchymal pseudocysts in nonaerated lung areas, was found in 26 of the 30 lungs examined (86%). Patients with severe airspace enlargement (2.6–40 mm internal diameter) had a significantly greater incidence of pneumothorax (8 versus 2,<Emphasis Type="Italic">p</Emphasis><0.05), were ventilated using higher peak airway pressures (56±18 cmH<Subscript>2</Subscript>O versus 44±10 cmH<Subscript>2</Subscript>O,<Emphasis Type="Italic">p</Emphasis><0.05) and tidal volumes (12±3 ml/kg, versus 9±2ml/kg,<Emphasis Type="Italic">p</Emphasis><0.05) were exposed significantly longer to toxic levels of oxygen (8.6±9.4 days versus 1.9±2 days at FIO<Subscript>2</Subscript>>0.6,<Emphasis Type="Italic">p</Emphasis><0.05) and lost more weight (6.3±9.2 kg versus 0.75±5.8 kg,<Emphasis Type="Italic">p</Emphasis><0.05) than patients with mild airspace enlargement (1–2.5 mm internal diameter).</Para></AbstractSection><AbstractSection ID="Asec6"><Heading>Conclusion</Heading><Para>Underlying histologic lesions responsible for clinical lung barotrauma consist of pleural cysts, bronchiolar dilatation, alveolar overdistension and intraparenchymal pseudocysts. Mechanical ventilation appears to be an aggravating factor, particularly when high peak airway pressures and large tidal volumes are delivered by the ventilator.</Para></AbstractSection></Abstract><KeywordGroup Language="En"><Heading>Key words</Heading><Keyword>Mechanical ventilation</Keyword><Keyword>Barotrauma</Keyword><Keyword>Respiratory failure</Keyword><Keyword>Alveolar overdistension</Keyword><Keyword>Pneumothorax</Keyword></KeywordGroup><ArticleNote Type="PresentedAt"><SimplePara>Presented in part at the 32ème Congrès de la Société Française d'Anesthésie-Réanimation, Septembre 1990, Paris, France</SimplePara></ArticleNote></ArticleHeader><NoBody></NoBody></Article></Issue></Volume></Journal></Publisher></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Histologic aspects of pulmonary barotrauma in critically ill patients with acute respiratory failure</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Histologic aspects of pulmonary barotrauma in critically ill patients with acute respiratory failure</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="termsOfAddress">Dr.</namePart><namePart type="given">J.</namePart><namePart type="given">J.</namePart><namePart type="family">Rouby</namePart><affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">T.</namePart><namePart type="family">Lherm</namePart><affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">E.</namePart><namePart type="family">Martin de Lassale</namePart><affiliation>Department of Pathology, Hôpital de la Pitié-Salpêtrière, Université Paris VI, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P.</namePart><namePart type="family">Poète</namePart><affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">L.</namePart><namePart type="family">Bodin</namePart><affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="given">F.</namePart><namePart type="family">Finet</namePart><affiliation>Department of Pathology, Hôpital de la Pitié-Salpêtrière, Université Paris VI, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P.</namePart><namePart type="family">Callard</namePart><affiliation>Department of Pathology, Hôpital Jean Verdier, Université Paris XIII, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P.</namePart><namePart type="family">Viars</namePart><affiliation>Department of Anesthesiology, Unité de Réanimation Chirurgicale, Hôpital de la Pitié-Salpêtrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="OriginalPaper"></genre><originInfo><publisher>Springer-Verlag</publisher><place><placeTerm type="text">Berlin/Heidelberg</placeTerm></place><dateCreated encoding="w3cdtf">1993-01-22</dateCreated><dateIssued encoding="w3cdtf">1993-07-01</dateIssued><copyrightDate encoding="w3cdtf">1993</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Abstract: Objective: To describe histologically pulmonary barotrauma in mechanically ventilated patients with severe acute respiratory failure. Design: Assessment of histologic pulmonary barotrauma. Setting: A 14-bed surgical intensive care unit (SICU). Patients: The lungs of 30 young critically ill patients (mean age 34±10 years) were histologically examined in the immediate post-mortem period. None of them were suspected of pre-existing emphysema. Measurements and results: Clinical events and ventilatory settings used during mechanical ventilation were compared with lung histology. Airspace enlargement, defined as the presence of either alveolar overdistension in aerated lung areas or intraparenchymal pseudocysts in nonaerated lung areas, was found in 26 of the 30 lungs examined (86%). Patients with severe airspace enlargement (2.6–40 mm internal diameter) had a significantly greater incidence of pneumothorax (8 versus 2,p<0.05), were ventilated using higher peak airway pressures (56±18 cmH2O versus 44±10 cmH2O,p<0.05) and tidal volumes (12±3 ml/kg, versus 9±2ml/kg,p<0.05) were exposed significantly longer to toxic levels of oxygen (8.6±9.4 days versus 1.9±2 days at FIO2>0.6,p<0.05) and lost more weight (6.3±9.2 kg versus 0.75±5.8 kg,p<0.05) than patients with mild airspace enlargement (1–2.5 mm internal diameter). Conclusion: Underlying histologic lesions responsible for clinical lung barotrauma consist of pleural cysts, bronchiolar dilatation, alveolar overdistension and intraparenchymal pseudocysts. Mechanical ventilation appears to be an aggravating factor, particularly when high peak airway pressures and large tidal volumes are delivered by the ventilator.</abstract><note>Originals/Rapid Publication</note><note>Presented in part at the 32ème Congrès de la Société Française d'Anesthésie-Réanimation, Septembre 1990, Paris, France</note><relatedItem type="host"><titleInfo><title>Intensive Care Medicine</title></titleInfo><titleInfo type="abbreviated"><title>Intensive Care Med</title></titleInfo><genre type="Journal" displayLabel="Archive Journal"></genre><originInfo><dateIssued encoding="w3cdtf">1993-07-01</dateIssued><copyrightDate encoding="w3cdtf">1993</copyrightDate></originInfo><subject><genre>Medicine & Public Health</genre><topic>Anesthesiology</topic><topic>Emergency Medicine</topic><topic>Intensive / Critical Care Medicine</topic><topic>Pneumology/Respiratory System</topic><topic>Pain Medicine</topic><topic>Pediatrics</topic></subject><identifier type="ISSN">0342-4642</identifier><identifier type="eISSN">1432-1238</identifier><identifier type="JournalID">134</identifier><identifier type="IssueArticleCount">18</identifier><identifier type="VolumeIssueCount">8</identifier><part><date>1993</date><detail type="volume"><number>19</number><caption>vol.</caption></detail><detail type="issue"><number>7</number><caption>no.</caption></detail><extent unit="pages"><start>383</start><end>389</end></extent></part><recordInfo><recordOrigin>Springer-Verlag, 1993</recordOrigin></recordInfo></relatedItem><identifier type="istex">C53D584806661D171CD3F0F63F8450C95A67741F</identifier><identifier type="DOI">10.1007/BF01724877</identifier><identifier type="ArticleID">Art6</identifier><identifier type="ArticleID">BF01724877</identifier><accessCondition type="use and reproduction" contentType="copyright">Springer-Verlag</accessCondition><recordInfo><recordContentSource>SPRINGER</recordContentSource><recordOrigin>Springer-Verlag, 1993</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Musique/explor/MagnificatV1/Data/Istex/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000217 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Istex/Corpus/biblio.hfd -nk 000217 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Musique
|area= MagnificatV1
|flux= Istex
|étape= Corpus
|type= RBID
|clé= ISTEX:C53D584806661D171CD3F0F63F8450C95A67741F
|texte= Histologic aspects of pulmonary barotrauma in critically ill patients with acute respiratory failure
}}
| This area was generated with Dilib version V0.6.31. |  |