Effects on Pulmonary Vascular Mechanics of Two Different Lung-Protective Ventilation Strategies in an Experimental Model of Acute Respiratory Distress Syndrome.

Abstract:

OBJECTIVES:To compare the effects of two lung-protective ventilation strategies on pulmonary vascular mechanics in early acute respiratory distress syndrome. DESIGN:Experimental study. SETTING:University animal research laboratory. SUBJECTS:Twelve pigs (30.8 ± 2.5 kg). INTERVENTIONS:Acute respiratory distress syndrome was induced by repeated lung lavages and injurious mechanical ventilation. Thereafter, animals were randomized to 4 hours ventilation according to the Acute Respiratory Distress Syndrome Network protocol or to an open lung approach strategy. Pressure and flow sensors placed at the pulmonary artery trunk allowed continuous assessment of pulmonary artery resistance, effective elastance, compliance, and reflected pressure waves. Respiratory mechanics and gas exchange data were collected. MEASUREMENTS AND MAIN RESULTS:Acute respiratory distress syndrome led to pulmonary vascular mechanics deterioration. Four hours after randomization, pulmonary vascular mechanics was similar in Acute Respiratory Distress Syndrome Network and open lung approach: resistance (578 ± 252 vs 626 ± 153 dyn.s/cm; p = 0.714), effective elastance, (0.63 ± 0.22 vs 0.58 ± 0.17 mm Hg/mL; p = 0.710), compliance (1.19 ± 0.8 vs 1.50 ± 0.27 mL/mm Hg; p = 0.437), and reflection index (0.36 ± 0.04 vs 0.34 ± 0.09; p = 0.680). Open lung approach as compared to Acute Respiratory Distress Syndrome Network was associated with improved dynamic respiratory compliance (17.3 ± 2.6 vs 10.5 ± 1.3 mL/cm H2O; p < 0.001), driving pressure (9.6 ± 1.3 vs 19.3 ± 2.7 cm H2O; p < 0.001), and venous admixture (0.05 ± 0.01 vs 0.22 ± 0.03, p < 0.001) and lower mean pulmonary artery pressure (26 ± 3 vs 34 ± 7 mm Hg; p = 0.045) despite of using a higher positive end-expiratory pressure (17.4 ± 0.7 vs 9.5 ± 2.4 cm H2O; p < 0.001). Cardiac index, however, was lower in open lung approach (1.42 ± 0.16 vs 2.27 ± 0.48 L/min; p = 0.005). CONCLUSIONS:In this experimental model, Acute Respiratory Distress Syndrome Network and open lung approach affected pulmonary vascular mechanics similarly. The use of higher positive end-expiratory pressures in the open lung approach strategy did not worsen pulmonary vascular mechanics, improved lung mechanics, and gas exchange but at the expense of a lower cardiac index.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Santos A,Gomez-Peñalver E,Monge-Garcia MI,Retamal J,Borges JB,Tusman G,Hedenstierna G,Larsson A,Suarez-Sipmann F

doi

10.1097/CCM.0000000000002701

subject

Has Abstract

pub_date

2017-11-01 00:00:00

pages

e1157-e1164

issue

11

eissn

0090-3493

issn

1530-0293

journal_volume

45

pub_type

杂志文章
  • Cardiogenic shock.

    abstract::Cardiogenic shock is the most common cause of death in patients hospitalized with acute myocardial infarction and is associated with a poor prognosis. More than 75% of cases are due to extensive left ventricular infarction and ventricular failure. Other causes include right ventricular infarction and papillary muscle ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/01.CCM.0000296268.57993.90

    authors: Topalian S,Ginsberg F,Parrillo JE

    更新日期:2008-01-01 00:00:00

  • Inhibiting α5 Subunit-Containing γ-Aminobutyric Acid Type A Receptors Attenuates Cognitive Deficits After Traumatic Brain Injury.

    abstract:OBJECTIVES:Cognitive deficits after traumatic brain injury are a leading cause of disability worldwide, yet no effective pharmacologic treatments exist to improve cognition. Traumatic brain injury increases proinflammatory cytokines, which trigger excess function of α5 subunit-containing γ-aminobutyric acid type A rece...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000004161

    authors: Khodaei S,Avramescu S,Wang DS,Sheng H,Chan NK,Lecker I,Fernandez-Escobar A,Lei G,Dewar MB,Whissell PD,Baker AJ,Orser BA

    更新日期:2020-04-01 00:00:00

  • Pharmacokinetics of continuous infusions of fentanyl in critically ill children.

    abstract:OBJECTIVE:To determine the pharmacokinetics of fentanyl when used as a long-term continuous infusion for sedation/analgesia in mechanically ventilated critically ill infants and children. DESIGN:Prospective, case series. SETTING:A university hospital pediatric intensive care unit (ICU). PATIENTS:Nineteen mechanicall...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199307000-00012

    authors: Katz R,Kelly HW

    更新日期:1993-07-01 00:00:00

  • Spontaneous gasping increases the ability to resuscitate during experimental cardiopulmonary resuscitation.

    abstract:OBJECTIVE:To evaluate the effect of spontaneous gasping on cardiorespiratory functions and the ability to resuscitate during experimental cardiac arrest. DATA SOURCES:Studies in rat and pig models during cardiac arrest and cardiopulmonary resuscitation (CPR). STUDY SELECTION:We retrospectively examined the role of sp...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199405000-00027

    authors: Yang L,Weil MH,Noc M,Tang W,Turner T,Gazmuri RJ

    更新日期:1994-05-01 00:00:00

  • β-lactam Therapeutic Drug Management in the PICU.

    abstract:OBJECTIVES:To determine whether contemporary β-lactam anti-infective dosing recommendations in critically ill children achieve concentrations associated with maximal anti-infective activity. The secondary objective was to describe the microbiological and clinical outcomes associated with β-lactam therapeutic drug manag...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000002817

    authors: Cies JJ,Moore WS 2nd,Enache A,Chopra A

    更新日期:2018-02-01 00:00:00

  • Additional value of procalcitonin for diagnosis of infection in patients with fever at the emergency department.

    abstract:OBJECTIVE:First, to determine whether procalcitonin (PCT) significantly adds diagnostic value in terms of sensitivity and specificity to a common set of markers of infection, including C-reactive protein (CRP), at the Emergency Department. Second, to create a simple scoring rule implementing PCT values. Third, to deter...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3181b9ec33

    authors: de Kruif MD,Limper M,Gerritsen H,Spek CA,Brandjes DP,ten Cate H,Bossuyt PM,Reitsma PH,van Gorp EC

    更新日期:2010-02-01 00:00:00

  • Prevention of colonization and infection in critically ill patients: a prospective randomized study.

    abstract::In a prospective randomized study to determine whether prevention of colonization of Gram-negative bacteria results in prevention of Gram-negative bacterial infections, 96 intensive care patients were randomly allocated into a control group and a study group. The study group received oral nonabsorbable antimicrobial a...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00003246-198811000-00001

    authors: Kerver AJ,Rommes JH,Mevissen-Verhage EA,Hulstaert PF,Vos A,Verhoef J,Wittebol P

    更新日期:1988-11-01 00:00:00

  • Monoclonal antibody to tumor necrosis factor-alpha attenuates hemodynamic dysfunction secondary to intestinal ischemia/reperfusion in rats.

    abstract:OBJECTIVE:To evaluate the effects of monoclonal antibody to tumor necrosis factor (TNF)-alpha on the hemodynamic alterations and survival rate in rats subjected to intestinal ischemia/reperfusion. DESIGN:Prospective, randomized study. SETTING:Animal laboratory of an institute for research in traumatology. SUBJECTS:M...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199609000-00020

    authors: Yao YM,Bahrami S,Redl H,Schlag G

    更新日期:1996-09-01 00:00:00

  • L-arginine: nitric oxide pathway in endotoxemia and human septic shock.

    abstract:OBJECTIVE:To investigate the relationship between nitric oxide production, endotoxemia, and hemodynamic alterations in human septic shock. DESIGN:Prospective study. SETTING:A 32-bed intensive care unit in a university referral hospital. PATIENTS:Two groups of septic patients with shock (n = 13) or without shock (n =...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199502000-00009

    authors: Gómez-Jiménez J,Salgado A,Mourelle M,Martín MC,Segura RM,Peracaula R,Moncada S

    更新日期:1995-02-01 00:00:00

  • Ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage.

    abstract:OBJECTIVE:To explore ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage. DESIGN:Population-based surveillance. SETTING:Corpus Christi, Texas. PATIENTS:All cases of intracerebral hemorrhage in the community of Corpus Christi, TX were ascertained as part of the Brain Attack Surveillance in ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3181a56755

    authors: Zahuranec DB,Brown DL,Lisabeth LD,Gonzales NR,Longwell PJ,Smith MA,Garcia NM,Morgenstern LB

    更新日期:2009-10-01 00:00:00

  • Pathophysiology of disseminated intravascular coagulation in sepsis.

    abstract::Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by intravascular fibrin formation occurring in the course of a variety of severe diseases. In gram-negative sepsis, endotoxin is the bacterial component eliciting a cascade of tissue factor dependent hypercoagulable reactions mediated b...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/00003246-200009001-00003

    authors: ten Cate H

    更新日期:2000-09-01 00:00:00

  • Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference.

    abstract:BACKGROUND:Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge. OBJECTIVES:To report on a 2-day Society of Critical Car...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/CCM.0b013e318232da75

    authors: Needham DM,Davidson J,Cohen H,Hopkins RO,Weinert C,Wunsch H,Zawistowski C,Bemis-Dougherty A,Berney SC,Bienvenu OJ,Brady SL,Brodsky MB,Denehy L,Elliott D,Flatley C,Harabin AL,Jones C,Louis D,Meltzer W,Muldoon SR,Pa

    更新日期:2012-02-01 00:00:00

  • Opposed effects of hypertonic saline on contusions and noncontused brain tissue in patients with severe traumatic brain injury.

    abstract:OBJECTIVE:The aim of this study was to quantify the effect of hypertonic saline solution on contused and noncontused brain tissue in patients with traumatic brain injury. We hypothesize that hypertonic saline would increase the volume of brain contusion while decreasing the volume of noncontused hemispheric areas. DES...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.CCM.0000243797.42346.64

    authors: Lescot T,Degos V,Zouaoui A,Préteux F,Coriat P,Puybasset L

    更新日期:2006-12-01 00:00:00

  • Importance of the infusion rate for the plasma expanding effect of 5% albumin, 6% HES 130/0.4, 4% gelatin, and 0.9% NaCl in the septic rat.

    abstract:OBJECTIVES:To compare the plasma volume (PV) expanding effect of a fast infusion rate with that of a slow infusion rate of a fixed volume of 5% albumin, of the synthetic colloids, 6% hydroxyethyl starch 130/0.4 and 4% gelatin, and of 0.9% NaCl in a rat sepsis model and to compare the plasma-expanding effect among these...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e318274157e

    authors: Bark BP,Persson J,Grände PO

    更新日期:2013-03-01 00:00:00

  • Written information that relatives of adult intensive care unit patients would like to receive--a comparison to published recommendations and opinion of staff members.

    abstract:OBJECTIVE:Information booklets have not been assessed by the families of intensive care unit (ICU) patients. This study explored the information that the relatives of adult ICU patients wanted to find in the information booklets. DESIGN:Multicenter survey. SETTING:Twenty-three French ICUs. SUBJECTS:One close relativ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1097/CCM.0b013e3181a03063

    authors: Soltner C,Lassalle V,Galienne-Bouygues S,Pottecher J,Floccard B,Delapierre L,Jungfer F,Sargentini C,Alberti C,Beydon L,Lifrea Group.

    更新日期:2009-07-01 00:00:00

  • Colonization with broad-spectrum cephalosporin-resistant gram-negative bacilli in intensive care units during a nonoutbreak period: prevalence, risk factors, and rate of infection.

    abstract:OBJECTIVE:To define the epidemiology of broad-spectrum cephalosporin-resistant gram-negative bacilli in intensive care units (ICUs) during a nonoutbreak period, including the prevalence, the risk factors for colonization, the frequency of acquisition, and the rate of infection. DESIGN:Prospective cohort study. SETTIN...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199906000-00026

    authors: D'Agata EM,Venkataraman L,DeGirolami P,Burke P,Eliopoulos GM,Karchmer AW,Samore MH

    更新日期:1999-06-01 00:00:00

  • Brain Injury Is More Common in Venoarterial Extracorporeal Membrane Oxygenation Than Venovenous Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis.

    abstract:OBJECTIVES:Despite the common occurrence of brain injury in patients undergoing extracorporeal membrane oxygenation, it is unclear which cannulation method carries a higher risk of brain injury. We compared the prevalence of brain injury between patients undergoing venoarterial and venovenous extracorporeal membrane ox...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000004618

    authors: Shoskes A,Migdady I,Rice C,Hassett C,Deshpande A,Price C,Hernandez AV,Cho SM

    更新日期:2020-12-01 00:00:00

  • Relationship Between ICU Length of Stay and Long-Term Mortality for Elderly ICU Survivors.

    abstract:OBJECTIVES:To evaluate the association between length of ICU stay and 1-year mortality for elderly patients who survived to hospital discharge in the United States. DESIGN:Retrospective cohort study of a random sample of Medicare beneficiaries who survived to hospital discharge, with 1- and 3-year follow-up, stratifie...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000001480

    authors: Moitra VK,Guerra C,Linde-Zwirble WT,Wunsch H

    更新日期:2016-04-01 00:00:00

  • Preclinical evaluation of epinephrine nebulization to reduce airway hyperemia and improve oxygenation after smoke inhalation injury.

    abstract:OBJECTIVE:Acute lung injury secondary to smoke inhalation is a major source of morbidity and mortality in burn patients. We tested the hypothesis that nebulized epinephrine would ameliorate pulmonary dysfunction secondary to acute lung injury by reducing airway hyperemia and edema formation and mediating bronchodilatat...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e318207ec52

    authors: Lange M,Hamahata A,Traber DL,Cox RA,Kulp GA,Nakano Y,Traber LD,Herndon DN,Enkhbaatar P

    更新日期:2011-04-01 00:00:00

  • Role of protein kinase C and phosphatases in the pulmonary vasculature of neonatal piglets.

    abstract:OBJECTIVE:Persistent pulmonary hypertension of the newborn is characterized by the presence of intense vasoconstriction and vascular remodeling. Protein tyrosine phosphorylation has been recognized as a critical regulatory element in signal transduction, because it is dynamically regulated by the opposing actions of pr...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00003246-200106000-00030

    authors: Berkenbosch JW,Baribeau J,Ferretti E,Perreault T

    更新日期:2001-06-01 00:00:00

  • Sleep and Work in ICU Physicians During a Randomized Trial of Nighttime Intensivist Staffing.

    abstract:OBJECTIVES:To compare sleep, work hours, and behavioral alertness in faculty and fellows during a randomized trial of nighttime in-hospital intensivist staffing compared with a standard daytime intensivist model. DESIGN:Prospective observational study. SETTING:Medical ICU of a tertiary care academic medical center du...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000003773

    authors: Bakhru RN,Basner M,Kerlin MP,Halpern SD,Hansen-Flaschen J,Rosen IM,Dinges DF,Schweickert WD

    更新日期:2019-07-01 00:00:00

  • Myocardial ischemia and weaning failure in patients with coronary artery disease: an update.

    abstract:OBJECTIVE:To determine the frequency and effects of weaning-related myocardial ischemia on weaning outcomes in patients with coronary artery disease. DESIGN:Prospective cohort study. SETTING:Medical and cardiac intensive care units of a 300-bed teaching community hospital. MEASUREMENTS AND MAIN RESULTS:Three-lead ST...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章

    doi:10.1097/00003246-199910000-00005

    authors: Srivastava S,Chatila W,Amoateng-Adjepong Y,Kanagasegar S,Jacob B,Zarich S,Manthous CA

    更新日期:1999-10-01 00:00:00

  • Early recovery after closed traumatic head injury: somatosensory evoked potentials and clinical findings.

    abstract:OBJECTIVE:To determine the ability of somatosensory evoked potentials (SEP) compared with clinical findings to monitor and predict recovery in patients suffering from closed head injury with predominantly diffuse axonal injury (DAI). DESIGN:Prospective cohort study. SETTING:Neurologic intensive care unit (ICU) of a u...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200103000-00005

    authors: Claassen J,Hansen HC

    更新日期:2001-03-01 00:00:00

  • Improving clinical trials of long-term outcomes.

    abstract::There is an increasing evidence that survivors of critical illness suffer from impaired health-related quality of life. There are relatively few studies that have evaluated the effect of interventions in clinical trials to improve these long-term outcomes. Studies to improve long-term outcomes after critical illness f...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3181922bb7

    authors: Rubenfeld GD

    更新日期:2009-01-01 00:00:00

  • Are autopsy findings still relevant to the management of critically ill patients in the modern era?

    abstract:OBJECTIVES:The purpose of this study was to determine the accuracy of clinical diagnoses compared to autopsy findings in critically ill patients in the current medical era. DESIGN:We conducted a retrospective, blinded review of matched medical records and postmortem findings in patients who died between June 2006 and ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3182a275b1

    authors: Fröhlich S,Ryan O,Murphy N,McCauley N,Crotty T,Ryan D

    更新日期:2014-02-01 00:00:00

  • Multiple organ dysfunction syndrome: exploring the paradigm of complex nonlinear systems.

    abstract:OBJECTIVES:The objectives of this article are to introduce and explore a novel paradigm based on complex nonlinear systems, and to evaluate its application to critical care research regarding the systemic host response and multiple organ dysfunction syndrome (MODS). DATA SOURCES:Published original work, review article...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/00003246-200007000-00003

    authors: Seely AJ,Christou NV

    更新日期:2000-07-01 00:00:00

  • Postextubation hypoxemia treated with a continuous positive airway pressure mask.

    abstract::Twenty-seven surgical patients who developed post-extubation hypoxemia unresponsive to routine respiration therapy (incentive spirometry and chest physical therapy) received continuous positive airway pressure (CPAP) delivered through a mask at an inspired oxygen fraction (FIO2) of 0.45. All patients responded with an...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198501000-00012

    authors: Dehaven CB Jr,Hurst JM,Branson RD

    更新日期:1985-01-01 00:00:00

  • Old Mice Demonstrate Organ Dysfunction as well as Prolonged Inflammation, Immunosuppression, and Weight Loss in a Modified Surgical Sepsis Model.

    abstract:OBJECTIVES:Our goal was to "reverse translate" the human response to surgical sepsis into the mouse by modifying a widely adopted murine intra-abdominal sepsis model to engender a phenotype that conforms to current sepsis definitions and follows the most recent expert recommendations for animal preclinical sepsis resea...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000003926

    authors: Stortz JA,Hollen MK,Nacionales DC,Horiguchi H,Ungaro R,Dirain ML,Wang Z,Wu Q,Wu KK,Kumar A,Foster TC,Stewart BD,Ross JA,Segal M,Bihorac A,Brakenridge S,Moore FA,Wohlgemuth SE,Leeuwenburgh C,Mohr AM,Moldawer LL,E

    更新日期:2019-11-01 00:00:00

  • Effect of calcium to reverse the electrocardiographic effects of hyperkalemia in the isolated rat heart: a prospective, dose-response study.

    abstract:OBJECTIVES:To determine: a) any heart site or tissue-specific differences in the response to increased perfusion potassium concentrations, and b) the cellular site (intracellular vs. extracellular) of the effect of calcium on reversing electrocardiographic effects of hyperkalemia. DESIGN:In vitro prospective, repeated...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:

    authors: Bisogno JL,Langley A,Von Dreele MM

    更新日期:1994-04-01 00:00:00

  • Deadspace to tidal volume ratio predicts successful extubation in infants and children.

    abstract:OBJECTIVE:Using a modification of the Bohr equation, single-breath carbon dioxide capnography is a noninvasive technology for calculating physiologic dead space (V(D)/V(T)). The objective of this study was to identify a minimal V(D)/V(T) value for predicting successful extubation from mechanical ventilation in pediatri...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章

    doi:10.1097/00003246-200006000-00059

    authors: Hubble CL,Gentile MA,Tripp DS,Craig DM,Meliones JN,Cheifetz IM

    更新日期:2000-06-01 00:00:00