Effect of positive end expiratory pressure on lung injury and haemodynamics during experimental acute respiratory distress syndrome treated with extracorporeal membrane oxygenation and near-apnoeic ventilation

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dc.catalogadoryvc
dc.contributor.authorAraos, Joaquin
dc.contributor.authorAlegría Vargas, Leyla
dc.contributor.authorGarcia, Aline
dc.contributor.authorCruces, Pablo
dc.contributor.authorSoto Muñoz, Dagoberto Igor
dc.contributor.authorErranz, Benjamín
dc.contributor.authorSalomon, Tatiana
dc.contributor.authorMedina, Tania
dc.contributor.authorGarcía Valdes, Patricio Hernán
dc.contributor.authorDubo, Sebastian
dc.contributor.authorBachmann Barron, María Consuelo
dc.contributor.authorBasoalto Escobar, Roque Ignacio
dc.contributor.authorValenzuela, Emilio Daniel
dc.contributor.authorRovegno Echavarría, Maximiliano David
dc.contributor.authorVera Alarcón, María Magdalena
dc.contributor.authorRetamal Montes, Jaime
dc.contributor.authorCornejo Rosas, Rodrigo Alfredo
dc.contributor.authorBugedo Tarraza, Guillermo
dc.contributor.authorBruhn, Alejandro
dc.date.accessioned2023-11-19T02:34:23Z
dc.date.available2023-11-19T02:34:23Z
dc.date.issued2021
dc.description.abstractBackground: Lung rest has been recommended during extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS). Whether positive end-expiratory pressure (PEEP) confers lung protection during ECMO for severe ARDS is unclear. We compared the effects of three different PEEP levels whilst applying near-apnoeic ventilation in a model of severe ARDS treated with ECMO. Methods: Acute respiratory distress syndrome was induced in anaesthetised adult male pigs by repeated saline lavage and injurious ventilation for 1.5 h. After ECMO was commenced, the pigs received standardised near-apnoeic ventilation for 24 h to maintain similar driving pressures and were randomly assigned to PEEP of 0, 10, or 20 cm H2O (n¼7 per group). Respiratory and haemodynamic data were collected throughout the study. Histological injury was assessed by a pathologist masked to PEEP allocation. Lung oedema was estimated by wet-to-dry-weight ratio. Results: All pigs developed severe ARDS. Oxygenation on ECMO improved with PEEP of 10 or 20 cm H2O, but did not in pigs allocated to PEEP of 0 cm H2O. Haemodynamic collapse refractory to norepinephrine (n¼4) and early death (n¼3) occurred after PEEP 20 cm H2O. The severity of lung injury was lowest after PEEP of 10 cm H2O in both dependent and non-dependent lung regions, compared with PEEP of 0 or 20 cm H2O. A higher wet-to-dry-weight ratio, indicating worse lung injury, was observed with PEEP of 0 cmH2O. Histological assessment suggested that lung injury was minimised with PEEP of 10 cm H2O. Conclusions: During near-apnoeic ventilation and ECMO in experimental severe ARDS, 10 cm H2O PEEP minimised lung injury and improved gas exchange without compromising haemodynamic stability.
dc.fechaingreso.objetodigital2023-11-19
dc.fuente.origenPREI
dc.identifier.doi10.1016/j.bja.2021.07.031
dc.identifier.issn0007-0912
dc.identifier.urihttps://doi.org/10.1016/j.bja.2021.07.031
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/75362
dc.information.autorucEscuela de Medicina ; Alegría Vargas, Leyla ; 0000-0002-0930-4452 ; 121090
dc.information.autorucEscuela de Medicina ; Soto Muñoz, Dagoberto Igor ; 0000-0002-7350-1530 ; 1008458
dc.information.autorucEscuela de Medicina ; García Valdes, Patricio Hernán ; S/I ; 1006675
dc.information.autorucEscuela de Medicina ; Bachmann Barron, María Consuelo ; 0000-0002-2006-0591 ; 215825
dc.information.autorucEscuela de Medicina ; Basoalto Escobar, Roque Ignacio ; 0000-0002-8908-7397 ; 1010703
dc.information.autorucEscuela de Medicina ; Valenzuela, Emilio Daniel ; 0000-0001-9758-3473 ; 1056714
dc.information.autorucEscuela de Medicina ; Rovegno Echavarría, Maximiliano David ; 0000-0002-2882-8024 ; 1004053
dc.information.autorucEscuela de Medicina ; Vera Alarcón, María Magdalena ; 0000-0002-2969-3408 ; 226652
dc.information.autorucEscuela de Medicina ; Retamal Montes, Jaime ; 0000-0002-6817-3659 ; 175147
dc.information.autorucEscuela de Medicina ; Bugedo Tarraza, Guillermo ; 0000-0001-7527-6202 ; 103776
dc.information.autorucEscuela de Medicina ; Bruhn, Alejandro ; 0000-0001-8034-1937 ; 741
dc.issue.numero5
dc.language.isoen
dc.nota.accesoContenido parcial
dc.pagina.final814
dc.pagina.inicio807
dc.revistaBritish journal of anaesthesia
dc.rightsacceso restringido
dc.subjectAcute respiratory distress syndrome
dc.subjectExtracorporeal membrane oxygenation
dc.subjectMechanical ventilation
dc.subjectPositive end expiratory pressure
dc.subjectVentilator induced lung injury
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.titleEffect of positive end expiratory pressure on lung injury and haemodynamics during experimental acute respiratory distress syndrome treated with extracorporeal membrane oxygenation and near-apnoeic ventilation
dc.typeartículo
dc.volumen127
sipa.codpersvinculados121090
sipa.codpersvinculados1008458
sipa.codpersvinculados1006675
sipa.codpersvinculados215825
sipa.codpersvinculados1010703
sipa.codpersvinculados1056714
sipa.codpersvinculados1004053
sipa.codpersvinculados226652
sipa.codpersvinculados175147
sipa.codpersvinculados103776
sipa.codpersvinculados741
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