Effects of PEEP on regional ventilation-perfusion mismatch in the acute respiratory distress syndrome.
Crit Care
; 26(1): 211, 2022 07 11.
Статья
в английский
| MEDLINE | ID: covidwho-1925796
ABSTRACT
PURPOSE:
In the acute respiratory distress syndrome (ARDS), decreasing Ventilation-Perfusion [Formula see text] mismatch might enhance lung protection. We investigated the regional effects of higher Positive End Expiratory Pressure (PEEP) on [Formula see text] mismatch and their correlation with recruitability. We aimed to verify whether PEEP improves regional [Formula see text] mismatch, and to study the underlying mechanisms.METHODS:
In fifteen patients with moderate and severe ARDS, two PEEP levels (5 and 15 cmH2O) were applied in random order. [Formula see text] mismatch was assessed by Electrical Impedance Tomography at each PEEP. Percentage of ventilation and perfusion reaching different ranges of [Formula see text] ratios were analyzed in 3 gravitational lung regions, leading to precise assessment of their distribution throughout different [Formula see text] mismatch compartments. Recruitability between the two PEEP levels was measured by the recruitment-to-inflation ratio method.RESULTS:
In the non-dependent region, at higher PEEP, ventilation reaching the normal [Formula see text] compartment (p = 0.018) increased, while it decreased in the high [Formula see text] one (p = 0.023). In the middle region, at PEEP 15 cmH2O, ventilation and perfusion to the low [Formula see text] compartment decreased (p = 0.006 and p = 0.011) and perfusion to normal [Formula see text] increased (p = 0.003). In the dependent lung, the percentage of blood flowing through the non-ventilated compartment decreased (p = 0.041). Regional [Formula see text] mismatch improvement was correlated to lung recruitability and changes in regional tidal volume.CONCLUSIONS:
In patients with ARDS, higher PEEP optimizes the distribution of both ventilation (in the non-dependent areas) and perfusion (in the middle and dependent lung). Bedside measure of recruitability is associated with improved [Formula see text] mismatch.ключевые слова
Полный текст:
Имеется в наличии
Коллекция:
Международные базы данных
база данных:
MEDLINE
Основная тема:
Respiratory Distress Syndrome
Тип исследования:
Экспериментальные исследования
/
Рандомизированные контролируемые испытания
Пределы темы:
Люди
Язык:
английский
Журнал:
Crit Care
Год:
2022
Тип:
Статья
Аффилированная страна:
S13054-022-04085-y
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