Is There an Optimal PEEP for Pulmonary Hemodynamics in Acute Injured Lungs?
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Le résumé fourni par la source
Abstract RATIONALE: Several methods exist for setting positive end-expiratory pressure (PEEP), often leading to different PEEP levels. These variations may not only influence respiratory mechanics but also affect other critical factors, such as pulmonary vascular responses. OBJECTIVES: The main goal of this study was to estimate the impact of PEEP on pulmonary hemodynamics in acutely injured lungs. We compared three strategies of PEEP titration – highest respiratory system compliance (CRS), electrical impedance tomography (EIT) crossing point, and positive end-expiratory transpulmonary pressure (PL) – in terms of PEEP level and pulmonary hemodynamics. METHODS: Experimental study in two porcine models of acute lung injury induced by surfactant lavage and high stretch ventilation: I) Bilateral(n=37), injury induced in both lungs, generating a highly recruitable model; and II) Asymmetrical(n=13), injury induced in one lung while the other was collapsed, generating a poorly recruitable model. In all experiments, a decremental PEEP titration was performed monitoring PL, EIT (collapse, overdistension, and regional ventilation), respiratory mechanics, and pulmonary and systemic hemodynamics. PRELIMINARY RESULTS: PEEP titration based on CRS, EIT, and end-expiratory PL, resulted in three different levels of optimal PEEP in bilateral lung injury: mean PEEP were 13±2cmH2O, 11±2cmH2O, and 9±3cmH2O cmH2O, respectively (p<0.001). Our model of bilateral lung injury is highly recruitable, with a median R/I ratio of 1.24 (0.90-1.40). In this model, PEEP had a quadratic relationship (U shape) with mean PAP, represented by the formula “MeanPAP=4-(1.5xPEEP)+(0.1xPEEP2)”, R2=0.94, p<0.001, and with RV transmural pressure. In the asymmetrical lung injury, only PEEP at expiratory PL slightly positive (6±4cmH2O) was lower than both PEEP at the EIT crossing point (9±2cmH2O, p=0.047) and PEEP at the highest CRS (9±3cmH2O, p=0.023). Our model of asymmetrical lung injury had low-to-moderate lung recruitability, with a median R/I ratio of 0.67(0.29-0.98). In this model, it was also evident the quadratic relationship between PEEP with mean PAP and with RV transmural pressure. We measured PVR to verify if the response in mean PAP to PEEP would represent the response in PVR, and PVR behaved exactly like mean PAP. Systemic hemodynamics behaved similarly to pigs with bilateral lung injury. CONCLUSIONS: In porcine models of acute lung injury, both very low and very high levels of PEEP may impair pulmonary hemodynamics. The relationship between mean PAP and PEEP has a U shape, with the best level of mean PAP at individualized levels of PEEP.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Is There an Optimal PEEP for Pulmonary Hemodynamics in Acute Injured Lungs?
- Date Crossref
- 01/05/2025
- Éditeur
- Oxford University Press (OUP)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Toronto Interdepartmental Division of Critical Care pays non établi dans la noticeUniversité ou école supérieure
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Washington University in St. Louis pays non établi dans la noticeUniversité ou école supérieure
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Uppsala University Hospital pays non établi dans la noticeÉtablissement de santé
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Akademiska Barnsjukhuset pays non établi dans la noticeÉtablissement de santé
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University of Concepción pays non établi dans la noticeUniversité ou école supérieure
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Universidade de São Paulo pays non établi dans la noticeUniversité ou école supérieure
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Hospital for Sick Children Translational Medicine pays non établi dans la noticeÉtablissement de santé
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St. Michael's Hospital pays non établi dans la noticeÉtablissement de santé
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Washington University in St Louis Pediatric Critical Care Medicine pays non établi dans la noticeUniversité ou école supérieure
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Surgical sciences pays non établi dans la noticeInstitution
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Department of Physiotherapy pays non établi dans la noticeInstitution
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University of Sao Paulo Cardiopulmonary Department pays non établi dans la noticeUniversité ou école supérieure
Interdepartmental Division of Critical Care — University of Toronto, Washington University in St. Louis et Uppsala University Hospital, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.