Aude Garnero

C Grivans

CA Stahl

Carol Hodgson

CL Hodgson

D Chiumello

David Tuxen

EA Suzumura

Gaëlle Corno

GFJ Matos de

H Wrigge

JA Katz

Jacques Durand-Gasselin

JB Borges

Jean-Michel Arnal

JH Bates

JM Arnal

L Gattinoni

L Papazian

P Caironi

R Fretschner

RG Brower

S Crotti

S Lindgren

SE Lapinsky

SM Maggiore

The ARDS Definition Task Force

Abstract
                Introduction
                Lung recruitment maneuvers followed by an individually titrated positive end-expiratory pressure (PEEP) are the key components of the open lung ventilation strategy in acute respiratory distress syndrome (ARDS). The staircase recruitment maneuver is a step-by-step increase in PEEP followed by a decremental PEEP trial. The duration of each step is usually 2 minutes without physiologic rationale.
              
                Methods
                In this prospective study, we measured the dynamic end-expiratory lung volume changes (ΔEELV) during an increase and decrease in PEEP to determine the optimal duration for each step. PEEP was progressively increased from 5 to 40 cmH2O and then decreased from 40 to 5 cmH2O in steps of 5 cmH2O every 2.5 minutes. The dynamic of ΔEELV was measured by direct spirometry as the difference between inspiratory and expiratory tidal volumes over 2.5 minutes following each increase and decrease in PEEP. ΔEELV was separated between the expected increased volume, calculated as the product of the respiratory system compliance by the change in PEEP, and the additional volume.
              
                Results
                Twenty-six early onset moderate or severe ARDS patients were included. Data are expressed as median [25th-75th quartiles]. During the increase in PEEP, the expected increased volume was achieved within 2[2-2] breaths. During the decrease in PEEP, the expected decreased volume was achieved within 1 [1–1] breath, and 95 % of the additional decreased volume was achieved within 8 [2–15] breaths. Completion of volume changes in 99 % of both increase and decrease in PEEP events required 29 breaths.
              
                Conclusions
                In early ARDS, most of the ΔEELV occurs within the first minute, and change is completed within 2 minutes, following an increase or decrease in PEEP.
              </jats:sec

Crossref

Critical Care

Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients

https://ccforum.biomedcentral.com/track/pdf/10.1186/s13054-015-1044-0?site=ccforum.biomedcentral.com

Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients

Abstract

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