Lung Opening and Closing during Ventilation of Acute Respiratory Distress Syndrome

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dc.contributor.authorCaironi, Pietro
dc.contributor.authorCressoni, Massimo
dc.contributor.authorChiumello, Davide
dc.contributor.authorRanieri, Marco
dc.contributor.authorQuintel, Michael
dc.contributor.authorRusso, Sebastiano G.
dc.contributor.authorCornejo, Rodrigo
dc.contributor.authorBugedo, Guillermo
dc.contributor.authorCarlesso, Eleonora
dc.contributor.authorRusso, Riccarda
dc.contributor.authorCaspani, Luisa
dc.contributor.authorGattinoni, Luciano
dc.date.accessioned2024-01-10T12:40:09Z
dc.date.available2024-01-10T12:40:09Z
dc.date.issued2010
dc.description.abstractRationale The effects of high positive end-expiratory pressure (PEEP) strictly depend on lung recruitability, which varies widely during acute respiratory distress syndrome (ARDS). Unfortunately, increasing PEEP may lead to opposing effects on two main factors potentially worsening the lung injury, that is, alveolar strain and intratidal opening and closing, being detrimental (increasing the former) or beneficial (decreasing the latter).
dc.description.abstractObjectives: To investigate how lung recruitability influences alveolar strain and intratidal opening and closing after the application of high PEEP.
dc.description.abstractMethods: We analyzed data from a database of 68 patients with acute lung injury or ARDS who underwent whole-lung computed tomography at 5, 15, and 45 cm H2O airway pressure.
dc.description.abstractMeasurements and Main Results: End-inspiratory nonaerated lung tissue was estimated from computed tomography pressure volume curves. Alveolar strain and opening and closing lung tissue were computed at 5 and 15 cm H2O PEEP. In patients with a higher percentage of potentially recruitable lung, the increase in PEEP markedly reduced opening and closing lung tissue (P < 0.001), whereas no differences were observed in patients with a lower percentage of potentially recruitable lung. In contrast, alveolar strain similarly increased in the two groups (P = 0.89). Opening and closing lung tissue was distributed mainly in the dependent and hilar lung regions, and it appeared to be an independent risk factor for death (odds ratio, 1.10 for each 10-g increase).
dc.description.abstractConclusions: In ARDS, especially in patients with higher lung recruitability, the beneficial impact of reducing intratidal alveolar opening and closing by increasing PEEP prevails over the effects of increasing alveolar strain.
dc.description.funderFondazione Hera di Milano for Translational and Competitive Research
dc.description.funderEli Lilly
dc.description.funderMaquet
dc.description.funderHemodec
dc.fechaingreso.objetodigital2024-05-20
dc.format.extent9 páginas
dc.fuente.origenWOS
dc.identifier.doi10.1164/rccm.200905-0787OC
dc.identifier.eissn1535-4970
dc.identifier.issn1073-449X
dc.identifier.pubmedidMEDLINE:19910610
dc.identifier.urihttps://doi.org/10.1164/rccm.200905-0787OC
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/77278
dc.identifier.wosidWOS:000280446500011
dc.information.autorucMedicina;Bugedo G;S/I;60490
dc.information.autorucMedicina;Cornejo R;S/I;146070
dc.issue.numero6
dc.language.isoen
dc.nota.accesocontenido parcial
dc.pagina.final586
dc.pagina.inicio578
dc.publisherAMER THORACIC SOC
dc.revistaAMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
dc.rightsacceso restringido
dc.subjectacute respiratory distress syndrome
dc.subjectacute lung injury
dc.subjectventilator-induced lung injury
dc.subjectmechanical ventilation
dc.subjectEND-EXPIRATORY PRESSURE
dc.subjectMECHANICAL VENTILATION
dc.subjectTIDAL VOLUME
dc.subjectREGIONAL-DISTRIBUTION
dc.subjectTRANSPULMONARY PRESSURE
dc.subjectRECRUITMENT MANEUVERS
dc.subjectPULMONARY-EDEMA
dc.subjectINJURY
dc.subjectSTRATEGY
dc.subjectHYPERINFLATION
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleLung Opening and Closing during Ventilation of Acute Respiratory Distress Syndrome
dc.typeartículo
dc.volumen181
sipa.codpersvinculados60490
sipa.codpersvinculados146070
sipa.indexWOS
sipa.indexScopus
sipa.trazabilidadCarga SIPA;09-01-2024
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