End-inspiratory pause prolongation in acute respiratory distress syndrome patients : effects on gas exchange and mechanics
Aguirre-Bermeo, Hernan (Institut d'Investigació Biomèdica Sant Pau)
Morán, Indalecio (Institut d'Investigació Biomèdica Sant Pau)
Bottiroli, Maurizio (Ospedale Niguarda Ca' Granda, Milan, Italy)
Italiano, Stefano (Institut d'Investigació Biomèdica Sant Pau)
Parrilla-Gómez, Francisco José (Institut d'Investigació Biomèdica Sant Pau)
Plazolles, Eugenia (Institut d'Investigació Biomèdica Sant Pau)
Roche-Campo, Ferran (Hospital de Tortosa Verge de la Cinta)
Mancebo, Jordi (Jordi) (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Data:	2016
Resum:	End-inspiratory pause (EIP) prolongation decreases dead space-to-tidal volume ratio (Vd/Vt) and PaCO. We do not know the physiological benefits of this approach to improve respiratory system mechanics in acute respiratory distress syndrome (ARDS) patients when mild hypercapnia is of no concern. The investigation was conducted in an intensive care unit of a university hospital, and 13 ARDS patients were included. The study was designed in three phases. First phase, baseline measurements were taken. Second phase, the EIP was prolonged until one of the following was achieved: (1) EIP of 0. 7 s; (2) intrinsic positive end-expiratory pressure ≥1 cmHO; or (3) inspiratory-expiratory ratio 1:1. Third phase, the Vt was decreased (30 mL every 30 min) until PaCO equal to baseline was reached. FiO, PEEP, airflow and respiratory rate were kept constant. EIP was prolonged from 0. 12 ± 0. 04 to 0. 7 s in all patients. This decreased the Vd/Vt and PaCO (0. 70 ± 0. 07 to 0. 64 ± 0. 08, p < 0. 001 and 54 ± 9 to 50 ± 8 mmHg, p = 0. 001, respectively). In the third phase, the decrease in Vt (from 6. 3 ± 0. 8 to 5. 6 ± 0. 8 mL/Kg PBW, p < 0. 001) allowed to decrease plateau pressure and driving pressure (24 ± 3 to 22 ± 3 cmHO, p < 0. 001 and 13. 4 ± 3. 6 to 10. 9 ± 3. 1 cmHO, p < 0. 001, respectively) and increased respiratory system compliance from 29 ± 9 to 32 ± 11 mL/cmHO (p = 0. 001). PaO did not significantly change. Prolonging EIP allowed a significant decrease in Vt without changes in PaCO in passively ventilated ARDS patients. This produced a significant decrease in plateau pressure and driving pressure and significantly increased respiratory system compliance, which suggests less overdistension and less dynamic strain.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	End-inspiratory pause ; Dead space ; Tidal volume ; Acute respiratory distress syndrome ; Mechanical ventilation
Publicat a:	Annals of Intensive Care, Vol. 6 (august 2016) , ISSN 2110-5820

DOI: 10.1186/s13613-016-0183-z
PMID: 27558174

8 p, 933.1 KB

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