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01.11.2006 | Experimental

Monitoring dead space during recruitment and PEEP titration in an experimental model

verfasst von: Gerardo Tusman, Fernando Suarez-Sipmann, Stephan H. Böhm, Tanja Pech, Hajo Reissmann, Gustavo Meschino, Adriana Scandurra, Göran Hedenstierna

Erschienen in: Intensive Care Medicine | Ausgabe 11/2006

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Abstract

Objective

To test the usefulness of dead space for determining open-lung PEEP, the lowest PEEP that prevents lung collapse after a lung recruitment maneuver.

Design

Prospective animal study.

Setting

Department of Clinical Physiology, University of Uppsala, Sweden.

Subjects

Eight lung-lavaged pigs.

Interventions

Animals were ventilated using constant flow mode with VT of 6 ml/kg, respiratory rate of 30 bpm, inspiratory-to-expiratory ratio of 1 : 2, and FiO₂ of 1. Baseline measurements were performed at 6 cmH₂O of PEEP. PEEP was increased in steps of 6 cmH₂O from 6 to 24 cmH₂O. Recruitment maneuver was achieved within 2 min at pressure levels of 60/30 cmH₂O for Peak/PEEP. PEEP was decreased from 24 to 6 cmH₂O in steps of 2 cmH₂O and then to 0 cmH₂O. Each PEEP step was maintained for 10 min.

Measurements and results

Alveolar dead space (VD_alv), the ratio of alveolar dead space to alveolar tidal volume (VD_alv/VT_alv), and the arterial to end-tidal PCO₂ difference (Pa-etCO₂) showed a good correlation with PaO₂, normally aerated areas, and non-aerated CT areas in all animals (minimum–maximum r² = 0.83–0.99; p < 0.01). Lung collapse (non-aerated tissue > 5%) started at 12 cmH₂O PEEP; hence, open-lung PEEP was established at 14 cmH₂O. The receiver operating characteristics curve demonstrated a high specificity and sensitivity of VD_alv (0.89 and 0.90), VD_alv/VT_alv (0.82 and 1.00), and Pa − etCO₂ (0.93 and 0.95) for detecting lung collapse.

Conclusions

Monitoring of dead space was useful for detecting lung collapse and for establishing open-lung PEEP after a recruitment maneuver.

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Titel: Monitoring dead space during recruitment and PEEP titration in an experimental model
verfasst von: Gerardo Tusman
Fernando Suarez-Sipmann
Stephan H. Böhm
Tanja Pech
Hajo Reissmann
Gustavo Meschino
Adriana Scandurra
Göran Hedenstierna
Publikationsdatum: 01.11.2006
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 11/2006
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-006-0371-7

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Monitoring dead space during recruitment and PEEP titration in an experimental model