Determination of 'recruited volume' following a PEEP step is not a measure of lung recruitability.

Abstract:

BACKGROUND:It has been proposed that the analysis of positive end-expiratory pressure (PEEP)-induced volume changes can quantify alveolar recruitment. The potential of a lung to be recruited is expected to be high in acute respiratory distress syndrome (ARDS), where collapsed lung tissue is very common. The volume change that is beyond the delta volume because of the patient's compliance has been termed 'recruited volume' (RecV). However, data of patients with low and high RecV showed less severe lung disease in high 'recruiters', indicating that RecV may not equal the 'potentially recruitable lung tissue' seen in computed tomography scans. We hypothesized that RecV is higher in lung-healthy (LH) patients with little collapsed lung compared with ARDS patients. METHODS:RecV and inspiratory capacity (IC) were determined in 12 LH and in 25 ARDS patients during incremental PEEP (steps of 2 cmH2 O). RecV was determined as the time-dependent increase in end-expiratory volume following the first expiration to the new PEEP level (ΔTDV). Gas distribution in LH patients was analyzed by electric impedance tomography. RESULTS:Cumulative RecV(ΔTDV) and IC were higher (P < 0.01) in LH compared with ARDS patients, 1739 ml vs. 832 ml and 4432 ml vs. 2020 ml, respectively. In both groups, RecV correlated excellently with IC (R(2) = 0.86). In LH, RecV emanated mainly from nondependent lung regions at PEEP below 15 cmH2O. Maximum plateau pressure was reached with fewer PEEP steps in ARDS compared with LH patients (11 vs. 14, P < 0.01). CONCLUSION:Our findings suggest that RecV predominately measures a slow fraction of inflation of already aerated lung tissue and not recruitment of collapsed alveoli.

authors

Stahl CA,Möller K,Steinmann D,Henzler D,Lundin S,Stenqvist O

doi

10.1111/aas.12432

subject

Has Abstract

pub_date

2015-01-01 00:00:00

pages

35-46

issue

1

eissn

0001-5172

issn

1399-6576

journal_volume

59

pub_type

杂志文章
  • Effect of the menstrual cycle phase on post-operative pain perception and analgesic requirements.

    abstract:BACKGROUND:Research has shown that menstrual cycle phase may affect pain sensitivity. There is a lack of studies evaluating this effect on post-operative pain and analgesic needs. METHODS:In this prospective cohort study, we determined the effect of menstrual cycle phase on pain perception and analgesic requirements f...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/j.1399-6576.2012.02661.x

    authors: Ahmed A,Khan F,Ali M,Haqnawaz F,Hussain A,Azam SI

    更新日期:2012-05-01 00:00:00

  • Cell-mediated and humoral immune responses to total hip replacement under spinal or general anaesthesia.

    abstract::Regional anaesthesia has many advantages over general anaesthesia in hip surgery. When the effects of total hip replacement under spinal or general anaesthesia were compared in 22 patients, the only difference between the groups occurred in PHA-induced lymphocyte proliferative responses. In contrast, no differences be...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1111/j.1399-6576.1990.tb03078.x

    authors: Salo M,Nissilä M

    更新日期:1990-04-01 00:00:00

  • Anaesthetic practice and postoperative pulmonary complications.

    abstract::The aim of this study was to identify risk factors associated with postoperative pulmonary complications. The influence of the anaesthetic technique was evaluated (i.e. general contra regional anaesthesia and long contra intermediately acting muscle relaxants (pancuronium and atracurium)) taking into account the patie...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/j.1399-6576.1992.tb03570.x

    authors: Pedersen T,Viby-Mogensen J,Ringsted C

    更新日期:1992-11-01 00:00:00

  • Prediction of outcome from intensive care after gastroenterologic emergency.

    abstract::Prognostic factors determining the outcome from intensive care were studied in 952 patients admitted to 25 Finnish ICUs after gastroenterologic emergency. Logistic regression analysis was used to create predictive models based on the APACHE II-system. The models were constructed by using data from a random two-thirds ...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1111/j.1399-6576.1994.tb03957.x

    authors: Niskanen M,Kari A,Nikki P,Iisalo E,Kaukinen L,Rauhala V,Saarela E

    更新日期:1994-08-01 00:00:00

  • Segmental epidural analgesia and urinary excretion of catecholamines during labour.

    abstract::Urinary excretion of catecholamines was determined separately during the first stage of labour and during the period from the beginning of the second stage until 1/2 h after delivery in 16 healthy mothers, whose labours were induced at term. Seven mothers were given segmental epidural analgesia, at the height of TH10-...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/j.1399-6576.1977.tb01193.x

    authors: Jouppila R,Hollmén A,Jouppila P,Kärki N

    更新日期:1977-01-01 00:00:00

  • Paramedic helicopter emergency service in rural Finland - do benefits justify the cost?

    abstract:BACKGROUND:The benefit of the Helicopter Emergency Medical Service (HEMS) is not well documented. The aim of our study was to investigate the potential health benefits of HEMS, and their relation to cost of the service in a rural area in Finland. We also evaluated whether the patient benefit is due to early Advanced Li...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1034/j.1399-6576.2002.460704.x

    authors: Kurola J,Wangel M,Uusaro A,Ruokonen E

    更新日期:2002-08-01 00:00:00

  • Atelectasis and lung function in the postoperative period.

    abstract::Thirteen patients with healthy hearts and lungs, and with a mean age of 68 years, who were scheduled for lower abdominal surgery during isoflurane anaesthesia with muscular paralysis, were investigated with arterial blood gases, spirometry, pulmonary x-ray and computed tomography (CT) of the chest before and during an...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/j.1399-6576.1992.tb03516.x

    authors: Lindberg P,Gunnarsson L,Tokics L,Secher E,Lundquist H,Brismar B,Hedenstierna G

    更新日期:1992-08-01 00:00:00

  • Propofol 2 mg/kg is superior to propofol 1 mg/kg for tracheal intubation in children during sevoflurane induction.

    abstract:BACKGROUND:Propofol has been used to facilitate tracheal intubation within a short time of sevoflurane induction without a muscle relaxant in children. We compared as the primary outcome the incidence of excellent intubating conditions after 8% sevoflurane and propofol 1 or 2 mg/kg. METHODS:One hundred and four patien...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章,随机对照试验

    doi:10.1111/j.1399-6576.2011.02423.x

    authors: Siddik-Sayyid SM,Taha SK,Aouad MT,Abdallah FW,Al Alami AA,Kanazi GE

    更新日期:2011-05-01 00:00:00

  • The quality of manual chest compressions during transport--effect of the mattress assessed by dual accelerometers.

    abstract:BACKGROUND:The quality of cardiopulmonary resuscitation (CPR) has an impact on survival. The quality may be impaired if the patient needs to be transported to the hospital with ongoing CPR. The aim of this study was to analyse whether the quality of CPR can be improved during transportation by using real-time audiovisu...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/aas.12245

    authors: Hellevuo H,Sainio M,Huhtala H,Olkkola KT,Tenhunen J,Hoppu S

    更新日期:2014-03-01 00:00:00

  • Verification of endotracheal intubation in obese patients - temporal comparison of ultrasound vs. auscultation and capnography.

    abstract:BACKGROUND:Ultrasound (US) may have an emerging role as an adjunct in verification of endotracheal intubation. Obtaining optimal US images in obese patients is generally regarded more difficult than for other patients. This study compared the time consumption of bilateral lung US with auscultation and capnography for v...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/j.1399-6576.2011.02630.x

    authors: Pfeiffer P,Bache S,Isbye DL,Rudolph SS,Rovsing L,Børglum J

    更新日期:2012-05-01 00:00:00

  • Standardised assessment of competence in Focused Assessment with Sonography for Trauma.

    abstract:PURPOSE:The aim of this study was to develop and gather validity evidence for a standardised test of competence in Focused Assessment with Sonography for Trauma (FAST) and to define the appropriate cut-off point in simulation-based learning of the FAST protocol. METHODS:A 20-item simulation-based test for assessing co...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/aas.13141

    authors: Russell L,Østergaard ML,Nielsen MB,Konge L,Nielsen KR

    更新日期:2018-04-30 00:00:00

  • On the ropivacaine-reducing effect of low-dose sufentanil in intrathecal labor analgesia.

    abstract:BACKGROUND:Combining ropivacaine with sufentanil for intrathecal (i.t.) analgesia in labor is well recognized, but information on dosing is limited. This study aimed to determine the ED 50 of i.t. ropivacaine and to assess the effect of adding defined low doses of sufentanil. METHODS:This was a two-phase, double-blind...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章,随机对照试验

    doi:10.1111/j.1399-6576.2010.02254.x

    authors: Ortner CM,Posch M,Roessler B,Faybik P,Rützler K,Grabovica J,Kimberger O,Gustorff B

    更新日期:2010-09-01 00:00:00

  • Long-term pattern of opioid prescriptions after femoral shaft fractures.

    abstract:BACKGROUND:The use of opioids in non-cancer-related pain following skeletal trauma is controversial due to the presumed risk of dose escalation and dependence. We therefore examined the pattern of opioid prescriptions, that is, those actually dispensed, in patients with femoral shaft fractures. METHODS:We analysed dat...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/aas.12666

    authors: Al Dabbagh Z,Jansson KÅ,Stiller CO,Montgomery S,Weiss RJ

    更新日期:2016-05-01 00:00:00

  • Oxygen transport and mitochondrial function in porcine septic shock, cardiogenic shock, and hypoxaemia.

    abstract:INTRODUCTION:The relevance of tissue oxygenation in the pathogenesis of organ dysfunction during sepsis is controversial. We compared oxygen transport, lactate metabolism, and mitochondrial function in pigs with septic shock, cardiogenic shock, or hypoxic hypoxia. METHODS:Thirty-two anaesthetized, ventilated pigs were...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/j.1399-6576.2012.02706.x

    authors: Regueira T,Djafarzadeh S,Brandt S,Gorrasi J,Borotto E,Porta F,Takala J,Bracht H,Shaw S,Lepper PM,Jakob SM

    更新日期:2012-08-01 00:00:00

  • The hemodynamic effect of halothane in the normovolemic dog.

    abstract::With the aid of radioactive microspheres (labeled with 169Yb, 85Sr and 141Ce, respectively), the effect of halothane anesthesia on circulation was studied for 30 min and (group A) for 120 min of halothane anesthesia in thiopental-sedated dogs. Measurements were also carried out on recovery from halothane anesthesia. B...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/j.1399-6576.1978.tb01284.x

    authors: Ahlgren I,Aronsen KF,Björkman I,Wetterlin S

    更新日期:1978-01-01 00:00:00

  • Studies on fluid extravasation related to induced hypothermia during cardiopulmonary bypass in piglets.

    abstract:BACKGROUND:Hypothermia, commonly used for organ protection during cardiopulmonary bypass (CPB), has been associated with changes in plasma volume, hemoconcentration and microvascular fluid shifts. Fluid pathophysiology secondary to hypothermia and the mechanisms behind these changes are still largely unknown. In a rece...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1034/j.1399-6576.2001.045006720.x

    authors: Heltne JK,Koller ME,Lund T,Farstad M,Rynning SE,Bert JL,Husby P

    更新日期:2001-07-01 00:00:00

  • Anesthesia for cesarean section V: effects of enflurane anesthesia on the respiratory adaptation of the newborn in elective cesarean section.

    abstract::The new anesthetic inhalation agent, enflurane, is supposed to allow rapid induction and recovery. Experinece with this agent in obstetrics is limited. Enflurane was therefore studied in 14 pregnant women undergoing elective cesarean section. Its effects upon the respiratory adaptation of the newborn infants were foll...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/j.1399-6576.1976.tb05021.x

    authors: Magno R,Karlsson K,Selstam U,Wickström I

    更新日期:1976-01-01 00:00:00

  • Fusion of dispatching centres into one entity: effects on performance.

    abstract:BACKGROUND:Dispatching centres were fused into one of the 112 entity, which caused concerns regarding whether the medical calls could be processed effectively also in the new centre. We evaluated the effects of the reform on key performance criteria in medical calls. METHODS:This observational study in the Helsinki Di...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/j.1399-6576.2010.02243.x

    authors: Määttä T,Kuisma M,Väyrynen T,Nousila-Wiik M,Porthan K,Boyd J,Kuosmanen J,Räsänen P

    更新日期:2010-07-01 00:00:00

  • Assessment of acute stroke cerebral CT examinations by anaesthesiologists.

    abstract:BACKGROUND AND PURPOSE:It is essential to diagnose ischaemic stroke as soon as possible after symptom onset, so that thrombolytic treatment can be initiated as quickly as possible. This might be greatly facilitated if cerebral CT could be carried out in a pre-hospital setting. The aim of this study was to evaluate if a...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/aas.12542

    authors: Hov MR,Nome T,Zakariassen E,Russell D,Røislien J,Lossius HM,Lund CG

    更新日期:2015-10-01 00:00:00

  • Stability of an epidural analgesic solution containing adrenaline, bupivacaine and fentanyl.

    abstract:BACKGROUND:A low dose solution of adrenaline 2 microg x ml(-1), fentanyl 2 microg x ml(-1) and bupivacaine 1 mg x ml(-1) has been reported to give superior pain control when used for epidural analgesia after major surgery. The present paper describes the compounding and chemical stability of this triple-component solut...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1034/j.1399-6576.2000.440713.x

    authors: Kjønniksen I,Brustugun J,Niemi G,Breivik H,Anderssen E,Klem W

    更新日期:2000-08-01 00:00:00

  • Design and implementation of a closed-loop control system for infusion of propofol guided by bispectral index (BIS).

    abstract:BACKGROUND:This study describes the design of a hypnosis closed-loop control system with propofol. The controller used a proportional-integral (PI) algorithm with the bispectral index (BIS) as the feedback signal. Our hypothesis was that a PI closed-loop control could be applied in clinical practice safely keeping the ...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/j.1399-6576.2012.02738.x

    authors: Reboso JA,Méndez JA,Reboso HJ,León AM

    更新日期:2012-09-01 00:00:00

  • Intestinal and hepatic perfusion and metabolism in hypodynamic endotoxic shock. Effects of nitric oxide synthase inhibition.

    abstract:BACKGROUND:Inhibition of nitric oxide synthase (NOS) has been claimed to be beneficial in septic shock. We investigated the overall and regional effects of a NOS-inhibitor on perfusion and metabolism during severe endotoxic shock. METHODS:Nineteen anaesthetised pigs were catheterised and ultrasonic flow-probes were pl...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1034/j.1399-6576.1999.430113.x

    authors: Dahm PL,Thörne J,Myhre E,Grins E,Mårtensson L,Blomquist S

    更新日期:1999-01-01 00:00:00

  • Intraperitoneal lidocaine for postoperative pain after laparoscopy.

    abstract:BACKGROUND:A controversy exists over the effectiveness and clinical value of intraperitoneal local anaesthetics for treating pain after laparoscopic cholecystectomy. The use of intraperitoneal lidocaine was evaluated in this study. METHODS:At the end of surgery, 200 ml saline containing 200 mg lidocaine, or the same v...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1034/j.1399-6576.2000.440310.x

    authors: Elhakim M,Elkott M,Ali NM,Tahoun HM

    更新日期:2000-03-01 00:00:00

  • The reduction of pain on injection of propofol: the effect of addition of lignocaine.

    abstract::The effects of addition of 1 ml of lignocaine (10 mg) or isotonic saline to 19 ml of the emulsified preparation of propofol (Diprivan) were studied in a randomised, double-blind trial in 80 patients. The incidence and severity of pain on injection of propofol were significantly reduced by the addition of lignocaine (P...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1111/j.1399-6576.1988.tb02774.x

    authors: Helbo-Hansen S,Westergaard V,Krogh BL,Svendsen HP

    更新日期:1988-08-01 00:00:00

  • The cardiovascular response to ketamine: the effects of clonidine and lignocaine.

    abstract::The effectiveness of clonidine or lignocaine in reducing the cardiostimulatory effects of ketamine was studied. A double-blind, randomized design was used in three groups of 20 patients each, of ASA grade 1 or 2 presenting for minor elective surgery. The clonidine group received 0.3 mg clonidine orally with the premed...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1111/j.1399-6576.1993.tb03602.x

    authors: Munro HM,Sleigh JW,Paxton LD

    更新日期:1993-01-01 00:00:00

  • Vasopressor hormone response following mesenteric traction during major abdominal surgery.

    abstract:BACKGROUND:We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. METHODS:In a prospective, randomized, placebo-controlled study we administered 400...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1111/j.1399-6576.1998.tb05355.x

    authors: Brinkmann A,Seeling W,Wolf CF,Kneitinger E,Schönberger C,Vogt N,Orend KH,Büchler M,Radermacher P,Georgieff M

    更新日期:1998-09-01 00:00:00

  • Cognitive impairments after critical illness.

    abstract:BACKGROUND:Cognitive impairments are common after critical illness. Aetiology and effects of cognitive impairments in this setting are not fully revealed. The aim of this study was to investigate the effect of critical illness and intensive care unit (ICU) treatment on cerebral function. METHODS:Adult ICU patients wit...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/j.1399-6576.2011.02500.x

    authors: Torgersen J,Hole JF,Kvåle R,Wentzel-Larsen T,Flaatten H

    更新日期:2011-10-01 00:00:00

  • Plasma fluoride and bromide concentrations during occupational exposure to enflurane or halothane.

    abstract::The plasma fluoride and bromide concentrations were studied in operating theatre personnel. When enflurane was used, the increase in plasma fluoride concentration could not be distinguished from normal individual variations, but the plasma bromide concentration increased significantly when halothane was used. Seven pa...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/j.1399-6576.1985.tb02278.x

    authors: Carlsson P,Ekstrand J,Hallén B

    更新日期:1985-10-01 00:00:00

  • Application of the mixed venous blood concentration equation in desflurane anesthesia.

    abstract:BACKGROUND:We have previously proposed an equation derived from Fick's law and Lin's concept of effective blood concentration (EBC) to calculate the mixed venous blood concentration (MVBC) of isoflurane. Desflurane has a lower blood/air partition coefficient than isoflurane and, as such, promotes a faster induction and...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章

    doi:10.1111/j.1399-6576.2006.00887.x

    authors: Wu CC,Ho WM,Hung WT,Yang NC,Hwang KL,Wong KC

    更新日期:2006-05-01 00:00:00

  • The addition of fentanyl to 1.5 mg/ml ropivacaine has no advantage for paediatric epidural analgesia.

    abstract:BACKGROUND:Epidural opioids are frequently combined with local anaesthetics for an additive antinociceptive effect. We investigated the efficacy of epidural fentanyl to 1.25 or 1.5 mg/ml ropivacaine for post-operative epidural analgesia in children. METHODS:One hundred and eight children undergoing hypospadias repair ...

    journal_title:Acta anaesthesiologica Scandinavica

    pub_type: 杂志文章,随机对照试验

    doi:10.1111/j.1399-6576.2009.02046.x

    authors: Cho JE,Kim JY,Hong JY,Kil HK

    更新日期:2009-09-01 00:00:00