Choice of a Procedure for Optimizing Positive End-Expiratory Pressure in Patients with Acute Respiratory Distress Syndrome
Objective: to study the clinical efficiency of escalation and de-escalation procedures for optimizing positive end-expiratory pressure (PEEP) during mechanical ventilation (MV) in patients with acute respiratory distress syndrome (ARDS) resulting from direct and in indirect damaging factors. Subject...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
2012-02-01
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| Series: | Общая реаниматология |
| Online Access: | https://www.reanimatology.com/rmt/article/view/239 |
| Summary: | Objective: to study the clinical efficiency of escalation and de-escalation procedures for optimizing positive end-expiratory pressure (PEEP) during mechanical ventilation (MV) in patients with acute respiratory distress syndrome (ARDS) resulting from direct and in indirect damaging factors. Subjects and methods. During a prospective study, 46 examined patients (30 men, 16 women; their age was 21 to 67 years) with ARDS of different genesis were divided into 2 groups: 1) 22 patients (14 men and 8 women) in whom the causes of ARDS were direct damaging factors: gastric content aspiration, blunt chest injury with lung contusion, and acute bilateral bacterial pneumonia; 2) 24 patients (16 men and 8 women) in whom the causes of ARDS were indirect damaging factors: abdominal sepsis, severe nonthoracic injury, and acute massive blood loss. In Groups 1 and 2, the efficiency of the escalation and de-escalation procedures for PEEP optimization was compared during controlled MV with a managed object. Results. In the patients with ARDS caused by direct damaging factors, the escalation procedure for PEEP optimization was more effective than the de-escalation one. In those with ARDS caused by indirect damaging factors, the de-escalation procedure for PEEP optimization was more effective than the escalation one. Conclusion. It is expedient to use a differential approach to choosing an escalation or de-escalation procedure for PEEP optimization in patients with ARDS induced by direct and indirect damaging factors. Key words: acute respiratory distress syndrome; direct and indirect damaging factors; mechanical ventilation; positive end-expiratory pressure; escalation procedure for PEEP optimization; de-escalation procedure for PEEP optimization; lung opening maneuver. |
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| ISSN: | 1813-9779 2411-7110 |