ARDS: dramatic rises in arterial PO₂ with the 'open lung' approach

Excerpt

In a pilot study the 'open lung' concept was applied 22 times in 13 patients of a university medical intensive care unit with ARDS (lung injury score 3.7 ± 0.7) due to sepsis of various origin (APACHE II score 27.4 ± 6.3). Starting with the actual respirator adjustment, peak inspiratory pressure was increased by 10 cmH₂O every 3 min up to a mean pressure of 61 ± 9 cmH₂O, depending on the hemodynamic state and blood gas results of the patient. PEEP was increased to 15 to 25 cmH₂O. After achieving maximal elevation of arterial PaO₂, the peak pressure was then lowered to 30, maximal 40, cmH₂O and PEEP adjusted just above the alveolar occlusion pressure which guaranteed a tidal volume of about 6 ml/kg body weight. Under this regimen, FiO₂ could be significantly lowered from 0.9 to 0.55 with marked rise in oxygenation index from 100 ± 36 to 177 ± 63 mmHg in responders (15 maneuvers in 11 patients). Plain chest X-ray and CT scan showed marked reduction of signs of pulmonary infiltration in a very short time. …