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01-06-2011 | Experimental

Optimisation of positive end-expiratory pressure by forced oscillation technique in a lavage model of acute lung injury

Authors: Raffaele L. Dellacà, Emanuela Zannin, Peter Kostic, Marie Andersson Olerud, Pasquale P. Pompilio, Goran Hedenstierna, Antonio Pedotti, Peter Frykholm

Published in: Intensive Care Medicine | Issue 6/2011

Abstract

Purpose

We evaluated whether oscillatory compliance (C_X5) measured by forced oscillation technique (FOT) at 5 Hz may be useful for positive end-expiratory pressure (PEEP) optimisation.

Methods

We studied seven pigs in which lung injury was induced by broncho-alveolar lavage. The animals were ventilated in volume control mode with a tidal volume of 6 ml/kg. Forced oscillations were superimposed on the ventilation waveform for the assessment of respiratory mechanics. PEEP was increased from 0 to 24 cmH₂O in steps of 4 cmH₂O and subsequently decreased from 24 to 0 in steps of 2 cmH₂O. At each 8-min step, a CT scan was acquired during an end-expiratory hold, and blood gas analysis was performed. C_X5 was monitored continuously, and data relative to the expiratory hold were selected and averaged for comparison with CT and oxygenation.

Results

Open lung PEEP (PEEP_ol) was defined as the level of PEEP corresponding to the maximum value of C_X5 on the decremental limb of the PEEP trial. PEEP_ol was on average 13.4 (±1.0) cmH₂O. For higher levels of PEEP, there were no significant changes in the amount of non-aerated tissue (V_tissNA%). In contrast, when PEEP was reduced below PEEP_ol, V_tissNA% dramatically increased. PEEP_ol was able to prevent a 5% drop in V_tissNA% with 100% sensitivity and 92% specificity. At PEEP_ol V_tissNA% was significantly lower than at the corresponding PEEP level on the incremental limb.

Conclusions

The assessment of C_X5 allowed the definition of PEEP_ol to be in agreement with CT data. Thus, FOT measurements of C_X5 may provide a non-invasive bedside tool for PEEP titration.

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Title: Optimisation of positive end-expiratory pressure by forced oscillation technique in a lavage model of acute lung injury
Authors: Raffaele L. Dellacà
Emanuela Zannin
Peter Kostic
Marie Andersson Olerud
Pasquale P. Pompilio
Goran Hedenstierna
Antonio Pedotti
Peter Frykholm
Publication date: 01-06-2011
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 6/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-011-2211-7

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Springer Medicine

Optimisation of positive end-expiratory pressure by forced oscillation technique in a lavage model of acute lung injury

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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