Joel Dahl posted an update 3 months, 1 week ago
Acute Respiratory Distress Syndrome Network: Ventilation with reduce tidal volumes as compared with regular tidal volumes for acute lung injury and also the acute respiratory distress syndrome. N Engl J Med 2000, 342:1301-1308.On the other hand, the impact of pleural effusion on gas exchange, respiratory mechanics and response to optimistic end-expiratory stress (PEEP) in ALI/ARDS patients, throughout mechanical ventilation, has never ever been prospectively studied. Approaches Sufferers with a diagnosis of ALI/ARDS, who underwent a CT scan at 5 cmH2O PEEP for clinical causes, had been included inside the study. Lung and pleural effusion have been outlined separately; lung total weight and pleural effusion volume have been computed with committed software program. A PEEP test at five and 15 cmH2O with continuous minute ventilation was performed. Exclusion criteria had been: age <18 years, hemodynamic instability, chronic obstructive pulmonary disease and evidence of barotrauma. Results We enrolled 11 ALI/ARDS patients (10 male). The mean clinical characteristics on admission to the ICU were: age 67.5 ?9.9 years, BMI 24.4 ?2.1 kg/m2, PaO2/FiO2 203.1 ?56.1 mmHg, PEEP 9.1 ?2.8 cmH2O and pH 7.394 ?0.048. The volume of pleural effusion was not significantly related with the change in PaCO2 (r2 = 0.068; P = 0.437), PaO2 (r2 = 0.015; P = 0.722) and dead space (VD/VT) (r2 = 0.019; P = 0.682) going from PEEP 15 to PEEP 5 cmH2O. Conclusions Pleural effusion does not seem to influence the gasO train postural control by rewarding higher volumes of reaching outside exchange response to PEEP.P40 CT-scan lung morphology predicts the response to a recruitment maneuver in acute respiratory distress syndrome patientsJ Constantin1, S Grasso2, JJ Rouby3, E Futier1, B Gallix4, B Jung4, JE Baazin1, S Jaber4 1Hotel-Dieu Hospital, Clermont-Ferrand, France; 2Ospedale Policlinico, Bari, Italy; 3Piti?Salpetriere Hospital, Paris, France; 4Saint-Eloi Hospital, Montpellier, France Critical Care 2009, 13(Suppl 1):P40 (doi: 10.1186/cc7204) Introduction CT-scan lung morphology (lobar or nonlobar) is the main determinant of positive end-expiratory pressure (PEEP) response. Repartition of gas and tissue probably influences the response to a recruitment maneuver (RM), but to date there is no proof. The aim of this study was to assess RM-induced changes in lung morphology and gas exchange during and after RM in acute respiratory distress syndrome (ARDS) patients. Methods Nineteen patients with ARDS were included in the study. Patients were ventilated with volume control ventilation (Gallileo; Hamilton Medical, Bonaduz, Switzerland) with Vt = 6 ml/kg (ideal body weight) and respiratory rate to keep PaCO2 >55 mmHg with no intrinsic PEEP. After a first CT scan in zero end-expiratory pressure situations, a pressure olume curve was performed and the PEEP was set above the reduce inflection point. Soon after a stabilisation period, a second CT scan (in PEEP) was performed. Then a RM was performed, employing continuous good airway stress 40 cmH2O for 40 seconds. At the end with the RM (in between 35 and 39 s) a third CT scan was performed. Five minutes immediately after the RM, a fourth CT scan was performed in PEEP circumstances (identical amount of PEEP). Blood gas evaluation was sampled at every step on the study. CT-scan analysis was performed using certain volumetric application (IRMA). Results Ten males and nine girls, 63 ?11 years old, had been incorporated in the study.