Effects of expiratory tracheal gas insufflation in patients with severe head trauma and acute lung injury

Intensive Care Medicine
Melcior Martínez-PérezLluís Blanch

Abstract

This study analyzed the effect of phasic tracheal gas insufflation at mid- to end-expiration in patients with severe head trauma and acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). A prospective interventional study in a 16-bed intensive care unit. Seven patients with severe head trauma (Glasgow Coma Scale <9) and ALI/ARDS. Patients were ventilated in assist/control mode with a ventilatory strategy providing adequate oxygenation (PaO(2) >70 mmHg) and normocapnia (PaCO(2) between 35-40 mmHg). Mid to end expiratory tracheal gas insufflation at 8 l/min flow rate was delivered for 90 min while normocapnia was maintained by simultaneous reductions in tidal volume. We measured (hemodynamics, oxygenation, lung mechanics, and cerebral parameters) in basal situation and during and after tracheal insufflation. Tracheal gas insufflation allowed a significant decrease in tidal volume from 9.1 to 7.2 ml/kg, with associated reduction in driving pressure (plateau pressure minus positive end-expiratory pressure, PEEP) from 18.1 to 13.2 cm H(2)O. Total PEEP increased from 9.3 to 12.7 cm H(2)O due to the generation of lung hyperinflation. Oxygenation improved slightly during tracheal gas insufflation, and this improvement rem...Continue Reading

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Citations

Oct 21, 2006·Intensive Care Medicine·Luciana Mascia
Feb 9, 2006·Current Treatment Options in Neurology·Scott E Bell, Roman Hlatky
Aug 2, 2007·Critical Care Medicine·Ognjen Gajic, Edward M Manno
Oct 26, 2006·Artificial Organs·Martin WaldLieselotte Kirchner
Jul 13, 2013·Critical Care : the Official Journal of the Critical Care Forum·Charikleia S VrettouSpyros D Mentzelopoulos
Nov 10, 2005·Critical Care : the Official Journal of the Critical Care Forum·Jean-Jacques Rouby, Qin Lu
Jun 22, 2007·Critical Care : the Official Journal of the Critical Care Forum·Romina GonzalvoJosefina López-Aguilar
Dec 25, 2012·Medicina intensiva·J López-AguilarUNKNOWN GT-IRA de la SEMICYUC
Feb 22, 2008·Best Practice & Research. Clinical Anaesthesiology·Irene Rozet, Karen B Domino
Apr 15, 2017·American Journal of Physiology. Lung Cellular and Molecular Physiology·Parker J HuBrant M Wagener
Apr 7, 2007·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Raju T MeyappanDan Torbati
Jan 6, 2006·Current Opinion in Critical Care·Gregory J Lowe, Niall D Ferguson
Dec 22, 2011·Current Opinion in Critical Care·Maria E QuílezLluís Blanch

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