Positive End-Expiratory Pressure and Nitric Oxide Inhalation in the Treatment of Acute Respiratory Distress Syndrome
Objective: to evaluate the impact of positive end-expiratory pressure (PEEP) on hemodynamic and gas-exchange effects of inhaled nitric oxide (iNO) in patients with acute respiratory distress syndrome (ARDS).Subjects and methods. The study included 27 cardiosurgical patients with ARDS who were divide...
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| Format: | Article |
| Language: | English |
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Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
2007-12-01
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| Series: | Общая реаниматология |
| Subjects: | |
| Online Access: | https://www.reanimatology.com/rmt/article/view/903 |
| _version_ | 1826562359595892736 |
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| author | V. N. Poptsov D. A. Kosolapov Ye. V. Morozyuk A. S. Moshkov S. G. Ukhrenkov |
| author_facet | V. N. Poptsov D. A. Kosolapov Ye. V. Morozyuk A. S. Moshkov S. G. Ukhrenkov |
| author_sort | V. N. Poptsov |
| collection | DOAJ |
| description | Objective: to evaluate the impact of positive end-expiratory pressure (PEEP) on hemodynamic and gas-exchange effects of inhaled nitric oxide (iNO) in patients with acute respiratory distress syndrome (ARDS).Subjects and methods. The study included 27 cardiosurgical patients with ARDS who were divided into 2 groups, depending on the increment (A) in PaO2/FiO2 during iNO delivery (5 ppm): A PaO2/FiO2 > 15% [Group A (n=13)] and APaO2/FiO2 < 15% [Group B (n=14)]. The impact of different end-expiratory pressures (0, 4, 8, 12, and 16 cm H2O) on the parameters of pulmonary gas-exchange function, hemodynamics, O2 transport-uptake, respiratory biomechanics in the presence and absence of iNO delivery was examined.Results. In Groups A and B patients receiving no iNO, there were increases in PaO2/FiO2 and thoracopulmonary compliance (p<0.05), with end-expiratory pressure being elevated from 0 to 8 cm H2O. The rise of PEEP from 8 to 12 and 16 cm H2O in the absence of iNO delivery was not further accompanied by increased PaO2/FiO2 and thoracopulmonary compliance. Only in Group A, the effect of iNO on pulmonary oxygenating function was potentiated with end-expiratory pressure being increased from 0 to 8 cm: the increment of PaO2/FiO2 during iNO delivery accordingly increased from 21±3 to 38±6 mm Hg. In this group, a subsequent increase of PEEP to 12—16 cm H2O did not lead to the enhanced effect of iNO on arterial oxygenation.Conclusion. PEEP creation attended by increased thoracopulmonary compliance potentiates the effect of iNO on the pulmonary oxygenating function only in patients in whom the use of iNO is effective when end-expiratory pressure is zero. |
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| format | Article |
| id | doaj.art-5b4e635c32034a629ec09442e097a702 |
| institution | Directory Open Access Journal |
| issn | 1813-9779 2411-7110 |
| language | English |
| last_indexed | 2025-03-14T09:46:49Z |
| publishDate | 2007-12-01 |
| publisher | Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia |
| record_format | Article |
| series | Общая реаниматология |
| spelling | doaj.art-5b4e635c32034a629ec09442e097a7022025-03-02T11:29:27ZengFederal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, RussiaОбщая реаниматология1813-97792411-71102007-12-013615716310.15360/1813-9779-2007-6-157-163903Positive End-Expiratory Pressure and Nitric Oxide Inhalation in the Treatment of Acute Respiratory Distress SyndromeV. N. Poptsov0D. A. Kosolapov1Ye. V. Morozyuk2A. S. Moshkov3S. G. Ukhrenkov4Research Institute of Transplantology and Artificial Organs, Russian Agency for Health Care, MoscowResearch Institute of Transplantology and Artificial Organs, Russian Agency for Health Care, MoscowResearch Institute of Transplantology and Artificial Organs, Russian Agency for Health Care, MoscowResearch Institute of Transplantology and Artificial Organs, Russian Agency for Health Care, MoscowResearch Institute of Transplantology and Artificial Organs, Russian Agency for Health Care, MoscowObjective: to evaluate the impact of positive end-expiratory pressure (PEEP) on hemodynamic and gas-exchange effects of inhaled nitric oxide (iNO) in patients with acute respiratory distress syndrome (ARDS).Subjects and methods. The study included 27 cardiosurgical patients with ARDS who were divided into 2 groups, depending on the increment (A) in PaO2/FiO2 during iNO delivery (5 ppm): A PaO2/FiO2 > 15% [Group A (n=13)] and APaO2/FiO2 < 15% [Group B (n=14)]. The impact of different end-expiratory pressures (0, 4, 8, 12, and 16 cm H2O) on the parameters of pulmonary gas-exchange function, hemodynamics, O2 transport-uptake, respiratory biomechanics in the presence and absence of iNO delivery was examined.Results. In Groups A and B patients receiving no iNO, there were increases in PaO2/FiO2 and thoracopulmonary compliance (p<0.05), with end-expiratory pressure being elevated from 0 to 8 cm H2O. The rise of PEEP from 8 to 12 and 16 cm H2O in the absence of iNO delivery was not further accompanied by increased PaO2/FiO2 and thoracopulmonary compliance. Only in Group A, the effect of iNO on pulmonary oxygenating function was potentiated with end-expiratory pressure being increased from 0 to 8 cm: the increment of PaO2/FiO2 during iNO delivery accordingly increased from 21±3 to 38±6 mm Hg. In this group, a subsequent increase of PEEP to 12—16 cm H2O did not lead to the enhanced effect of iNO on arterial oxygenation.Conclusion. PEEP creation attended by increased thoracopulmonary compliance potentiates the effect of iNO on the pulmonary oxygenating function only in patients in whom the use of iNO is effective when end-expiratory pressure is zero.https://www.reanimatology.com/rmt/article/view/903acute respiratory distress syndromeinhaled nitric oxidepositive end-expiratory pressure |
| spellingShingle | V. N. Poptsov D. A. Kosolapov Ye. V. Morozyuk A. S. Moshkov S. G. Ukhrenkov Positive End-Expiratory Pressure and Nitric Oxide Inhalation in the Treatment of Acute Respiratory Distress Syndrome Общая реаниматология acute respiratory distress syndrome inhaled nitric oxide positive end-expiratory pressure |
| title | Positive End-Expiratory Pressure and Nitric Oxide Inhalation in the Treatment of Acute Respiratory Distress Syndrome |
| title_full | Positive End-Expiratory Pressure and Nitric Oxide Inhalation in the Treatment of Acute Respiratory Distress Syndrome |
| title_fullStr | Positive End-Expiratory Pressure and Nitric Oxide Inhalation in the Treatment of Acute Respiratory Distress Syndrome |
| title_full_unstemmed | Positive End-Expiratory Pressure and Nitric Oxide Inhalation in the Treatment of Acute Respiratory Distress Syndrome |
| title_short | Positive End-Expiratory Pressure and Nitric Oxide Inhalation in the Treatment of Acute Respiratory Distress Syndrome |
| title_sort | positive end expiratory pressure and nitric oxide inhalation in the treatment of acute respiratory distress syndrome |
| topic | acute respiratory distress syndrome inhaled nitric oxide positive end-expiratory pressure |
| url | https://www.reanimatology.com/rmt/article/view/903 |
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