Monitoring Expired CO2 Kinetics to Individualize Lung-Protective Ventilation in Patients With the Acute Respiratory Distress Syndrome
Mechanical ventilation (MV) is a lifesaving supportive intervention in the management of acute respiratory distress syndrome (ARDS), buying time while the primary precipitating cause is being corrected. However, MV can contribute to a worsening of the primary lung injury, known as ventilation-induce...
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| Format: | Article |
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Frontiers Media S.A.
2021-12-01
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| Series: | Frontiers in Physiology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphys.2021.785014/full |
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| author | Fernando Suárez-Sipmann Fernando Suárez-Sipmann Fernando Suárez-Sipmann Jesús Villar Jesús Villar Jesús Villar Carlos Ferrando Carlos Ferrando Carlos Ferrando Juan A. Sánchez-Giralt Gerardo Tusman |
| author_facet | Fernando Suárez-Sipmann Fernando Suárez-Sipmann Fernando Suárez-Sipmann Jesús Villar Jesús Villar Jesús Villar Carlos Ferrando Carlos Ferrando Carlos Ferrando Juan A. Sánchez-Giralt Gerardo Tusman |
| author_sort | Fernando Suárez-Sipmann |
| collection | DOAJ |
| description | Mechanical ventilation (MV) is a lifesaving supportive intervention in the management of acute respiratory distress syndrome (ARDS), buying time while the primary precipitating cause is being corrected. However, MV can contribute to a worsening of the primary lung injury, known as ventilation-induced lung injury (VILI), which could have an important impact on outcome. The ARDS lung is characterized by diffuse and heterogeneous lung damage and is particularly prone to suffer the consequences of an excessive mechanical stress imposed by higher airway pressures and volumes during MV. Of major concern is cyclic overdistension, affecting those lung segments receiving a proportionally higher tidal volume in an overall reduced lung volume. Theoretically, healthier lung regions are submitted to a larger stress and cyclic deformation and thus at high risk for developing VILI. Clinicians have difficulties in detecting VILI, particularly cyclic overdistension at the bedside, since routine monitoring of gas exchange and lung mechanics are relatively insensitive to this mechanism of VILI. Expired CO2 kinetics integrates relevant pathophysiological information of high interest for monitoring. CO2 is produced by cell metabolism in large daily quantities. After diffusing to tissue capillaries, CO2 is transported first by the venous and then by pulmonary circulation to the lung. Thereafter diffusing from capillaries to lung alveoli, it is finally convectively transported by lung ventilation for its elimination to the atmosphere. Modern readily clinically available sensor technology integrates information related to pulmonary ventilation, perfusion, and gas exchange from the single analysis of expired CO2 kinetics measured at the airway opening. Current volumetric capnography (VCap), the representation of the volume of expired CO2 in one single breath, informs about pulmonary perfusion, end-expiratory lung volume, dead space, and pulmonary ventilation inhomogeneities, all intimately related to cyclic overdistension during MV. Additionally, the recently described capnodynamic method provides the possibility to continuously measure the end-expiratory lung volume and effective pulmonary blood flow. All this information is accessed non-invasively and breath-by-breath helping clinicians to personalize ventilatory settings at the bedside and minimize overdistension and cyclic deformation of lung tissue. |
| first_indexed | 2024-12-19T12:28:15Z |
| format | Article |
| id | doaj.art-1d3ee48f7d1f4f8a8fc978ddf49aeeef |
| institution | Directory Open Access Journal |
| issn | 1664-042X |
| language | English |
| last_indexed | 2024-12-19T12:28:15Z |
| publishDate | 2021-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Physiology |
| spelling | doaj.art-1d3ee48f7d1f4f8a8fc978ddf49aeeef2022-12-21T20:21:29ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2021-12-011210.3389/fphys.2021.785014785014Monitoring Expired CO2 Kinetics to Individualize Lung-Protective Ventilation in Patients With the Acute Respiratory Distress SyndromeFernando Suárez-Sipmann0Fernando Suárez-Sipmann1Fernando Suárez-Sipmann2Jesús Villar3Jesús Villar4Jesús Villar5Carlos Ferrando6Carlos Ferrando7Carlos Ferrando8Juan A. Sánchez-Giralt9Gerardo Tusman10CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, SpainIntensive Care Unit, Hospital Universitario La Princesa, Madrid, SpainDepartment of Surgical Sciences, Anesthesiology & Critical Care, Hedenstierna Laboratory, Uppsala University Hospital, Uppsala, SwedenCIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, SpainMultidisciplinary Organ Dysfunction Evaluation Research Network (MODERN), Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, SpainKeenan Research Center at the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, CanadaCIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, SpainDepartment of Anesthesiology and Critical Care, Hospital Clinic, Barcelona, SpainHospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, SpainIntensive Care Unit, Hospital Universitario La Princesa, Madrid, SpainDepartment of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, ArgentinaMechanical ventilation (MV) is a lifesaving supportive intervention in the management of acute respiratory distress syndrome (ARDS), buying time while the primary precipitating cause is being corrected. However, MV can contribute to a worsening of the primary lung injury, known as ventilation-induced lung injury (VILI), which could have an important impact on outcome. The ARDS lung is characterized by diffuse and heterogeneous lung damage and is particularly prone to suffer the consequences of an excessive mechanical stress imposed by higher airway pressures and volumes during MV. Of major concern is cyclic overdistension, affecting those lung segments receiving a proportionally higher tidal volume in an overall reduced lung volume. Theoretically, healthier lung regions are submitted to a larger stress and cyclic deformation and thus at high risk for developing VILI. Clinicians have difficulties in detecting VILI, particularly cyclic overdistension at the bedside, since routine monitoring of gas exchange and lung mechanics are relatively insensitive to this mechanism of VILI. Expired CO2 kinetics integrates relevant pathophysiological information of high interest for monitoring. CO2 is produced by cell metabolism in large daily quantities. After diffusing to tissue capillaries, CO2 is transported first by the venous and then by pulmonary circulation to the lung. Thereafter diffusing from capillaries to lung alveoli, it is finally convectively transported by lung ventilation for its elimination to the atmosphere. Modern readily clinically available sensor technology integrates information related to pulmonary ventilation, perfusion, and gas exchange from the single analysis of expired CO2 kinetics measured at the airway opening. Current volumetric capnography (VCap), the representation of the volume of expired CO2 in one single breath, informs about pulmonary perfusion, end-expiratory lung volume, dead space, and pulmonary ventilation inhomogeneities, all intimately related to cyclic overdistension during MV. Additionally, the recently described capnodynamic method provides the possibility to continuously measure the end-expiratory lung volume and effective pulmonary blood flow. All this information is accessed non-invasively and breath-by-breath helping clinicians to personalize ventilatory settings at the bedside and minimize overdistension and cyclic deformation of lung tissue.https://www.frontiersin.org/articles/10.3389/fphys.2021.785014/fullvolumetric capnographydead spaceacute respiratory distress syndromeventilator-induced lung injurymechanical ventilation |
| spellingShingle | Fernando Suárez-Sipmann Fernando Suárez-Sipmann Fernando Suárez-Sipmann Jesús Villar Jesús Villar Jesús Villar Carlos Ferrando Carlos Ferrando Carlos Ferrando Juan A. Sánchez-Giralt Gerardo Tusman Monitoring Expired CO2 Kinetics to Individualize Lung-Protective Ventilation in Patients With the Acute Respiratory Distress Syndrome Frontiers in Physiology volumetric capnography dead space acute respiratory distress syndrome ventilator-induced lung injury mechanical ventilation |
| title | Monitoring Expired CO2 Kinetics to Individualize Lung-Protective Ventilation in Patients With the Acute Respiratory Distress Syndrome |
| title_full | Monitoring Expired CO2 Kinetics to Individualize Lung-Protective Ventilation in Patients With the Acute Respiratory Distress Syndrome |
| title_fullStr | Monitoring Expired CO2 Kinetics to Individualize Lung-Protective Ventilation in Patients With the Acute Respiratory Distress Syndrome |
| title_full_unstemmed | Monitoring Expired CO2 Kinetics to Individualize Lung-Protective Ventilation in Patients With the Acute Respiratory Distress Syndrome |
| title_short | Monitoring Expired CO2 Kinetics to Individualize Lung-Protective Ventilation in Patients With the Acute Respiratory Distress Syndrome |
| title_sort | monitoring expired co2 kinetics to individualize lung protective ventilation in patients with the acute respiratory distress syndrome |
| topic | volumetric capnography dead space acute respiratory distress syndrome ventilator-induced lung injury mechanical ventilation |
| url | https://www.frontiersin.org/articles/10.3389/fphys.2021.785014/full |
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