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High PEEP levels are associated with overdistension and tidal recruitment/derecruitment in ARDS patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory. Pontificia Univ Catolica Chile, Dept Med Intensiva, Fac Med, Santiago, Chile..
Pontificia Univ Catolica Chile, Dept Med Intensiva, Fac Med, Santiago, Chile..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.
Pontificia Univ Catolica Chile, Dept Med Intensiva, Fac Med, Santiago, Chile..
2015 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 9, 1161-1169 p.Article in journal (Refereed) Published
Abstract [en]

BackgroundPositive end-expiratory pressure (PEEP) improves gas exchange and respiratory mechanics, and it may decrease tissue injury and inflammation. The mechanisms of this protective effect are not fully elucidated. Our aim was to determine the intrinsic effects of moderate and higher levels of PEEP on tidal recruitment/derecruitment, hyperinflation, and lung mechanics, in patients with acute respiratory distress syndrome (ARDS). MethodsNine patients with ARDS of mainly pulmonary origin were ventilated sequential and randomly using two levels of PEEP: 9 and 15cmH(2)O, and studied with dynamic computed tomography at a fix transversal lung region. Tidal recruitment/derecruitment and hyperinflation were determined as non-aerated tissue and hyperinflated tissue variation between inspiration and expiration, expressed as percentage of total weight. We also assessed the maximal amount of non-aerated and hyperinflated tissue weight. ResultsPEEP 15cmH(2)O was associated with decrease in non-aerated tissue in all the patients (P<0.01). However, PEEP 15cmH(2)O did not decrease tidal recruitment/derecruitment compared to PEEP 9cmH(2)O (P=1). In addition, PEEP 15cmH(2)O markedly increased maximal hyperinflation (P<0.01) and tidal hyperinflation (P<0.05). Lung compliance decreased with PEEP 15cmH(2)O (P<0.001). ConclusionIn this series of patients with ARDS of mainly pulmonary origin, application of high levels of PEEP did not decrease tidal recruitment/derecruitment, but instead consistently increased tidal and maximal hyperinflation.

Place, publisher, year, edition, pages
2015. Vol. 59, no 9, 1161-1169 p.
National Category
Anesthesiology and Intensive Care Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-264023DOI: 10.1111/aas.12563ISI: 000360982900010PubMedID: 26061818OAI: oai:DiVA.org:uu-264023DiVA: diva2:859563
Funder
Swedish Heart Lung FoundationSwedish Research Council
Available from: 2015-10-07 Created: 2015-10-05 Last updated: 2017-12-01Bibliographically approved

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Retamal, JaimeLarsson, Anders

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