EFFECT OF 2 TIDAL VOLUMES ON OXYGENATION AND RESPIRATORY SYSTEM MECHANICS DURING THE EARLY-STAGE OF ADULT-RESPIRATORY-DISTRESS-SYNDROME

被引：23

作者：

BLANCH, L

FERNANDEZ, R

VALLES, J

SOLE, J

ROUSSOS, C

ARTIGAS, A

机构：

[1] Intensive Care Service, Hospital de Sabadell, Sabadell

[2] Critical Care Department, Evangelismos Hospital, Athens

[3] and Physiology Department, Universitat Autónoma de Barcelona

来源：

JOURNAL OF CRITICAL CARE | 1994年 / 9卷 / 03期

关键词：

D O I：

10.1016/0883-9441(94)90011-6

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Purpose: To study the effect of two tidal volumes on gas exchange, lung mechanics, and hemodynamics in 12 patients with acute respiratory distress syndrome (ARDS) within the first 72 hours of mechanical ventilation. Methods: Tidal volume (VT) was increased by 40% from the initial value at fixed positive end-expiratory pressure (PEEP) and matched minute ventilation by adjusting the respiratory rate (RR) of the ventilator. Initial VT and RR were 592 +/- 42 mL and 19 +/- 1 min 1, respectively. High VT amounted to 825 +/- 54 mL with a RR of 12 +/- 1 min-1. Results: We found that at high VT (1) the index of oxygenation increased from 0.22 +/- 0.03 to 0.32 +/- 0.04 (P < .001) with a parallel decrease in the right to left venous admixture from 0.26 +/- 0.02 to 0.23 +/- 0.02 (P < .001), and in the ratio of physiological dead space to tidal volume (VDS/VT) from 0.53 +/- 0.05 to 0.46 +/- 0.04 (P < .01), without impairment to hemodynamics and (2) respiratory system compliance improved significantly from 34.8 +/- 2.8 mL/cm H2O to 37.2 +/- 2.9 mL/cm H2O (P < .05). In 4 patients, we performed pressure-volume curves on PEEP with the ventilator finding an upward concavity reflecting progressive alveolar recruitment with increasing inflation volume in 3. Conclusions: High-tidal ventilation in the early stage of ARDS improved gas exchange, suggesting recruitment during the inspiratory phase. However, the benefit of better oxygenation should be weighed against the potential risk of barotrauma induced at high VT. Copyright (C) 1994 by W.B. Saunders Company

引用

页码：151 / 158

页数：8

共 37 条

[1]

Baker, Burki, Alterations in ventilatory pattern and ratio of dead-space to tidal volume, Chest, 92, pp. 1013-1017, (1987)

[2]

Blanch, Fernandez, Benito, Et al., Effect of PEEP on the arterial minus end-tidal carbon dioxide gradient, Chest, 92, pp. 451-454, (1987)

[3]

Blanch, Roussos, Brotherton, Et al., The effect of tidal volume and PEEP in ethchlorvynol-induced asymmetrical lung injury, J Appl Physiol, 73, pp. 108-116, (1992)

[4]

Burnham, Martin, Cheney, The effects of variuos tidal volumes on gas exchange in pulmonary edema, Anesthesiology, 37, pp. 27-32, (1972)

[5]

Craig, Pierson, Carrico, The clinical application of positive end-expiratory pressure (PEEP) in the adult respiratory distress syndrome, Respir Care, 30, pp. 184-201, (1985)

[6]

Dall'Ava-Santucci, Armangadiris, Brunet, Et al., Mechanical effects of PEEP in patients with adult respiratory distress syndrome, J Appl Physiol, 68, pp. 843-848, (1990)

[7]

Dantzker, Brook, Dehart, Et al., Ventilationperfusion distributions in the adult respiratory distress syndrome, Am Rev Respir Dis, 120, pp. 1039-1052, (1979)

[8]

Dreyfuss, Saumon, Lung overinflation: physiologic and anatomic alterations leading to pulmonary edema, Adult Respiratory Distress Syndrome, pp. 433-449, (1991)

[9]

Eissa, Ranieri, Corbeil, Et al., Analysis of behaviour of the respiratory system in ARDS patients: effects of flow, volume, and time, J Appl Physiol, 70, pp. 2719-2729, (1991)

[10]

Gattinoni, Pesenti, Avalli, Et al., Pressurevolume curve of total respiratory system in acute respiratory failure. Computed tomographic scan study, Am Rev Respir Dis, 136, pp. 730-736, (1987)

← 1 2 3 4 →