Lung protective ventilation (ARDSNet) versus airway pressure release ventilation: ventilatory management in a combined model of acute lung and brain injury

The Journal of Trauma and Acute Care Surgery
Stephen W DaviesEric A Toschlog

Abstract

Concomitant lung/brain traumatic injury results in significant morbidity and mortality. Lung protective ventilation (Acute Respiratory Distress Syndrome Network [ARDSNet]) has become the standard for managing adult respiratory distress syndrome; however, the resulting permissive hypercapnea may compound traumatic brain injury. Airway pressure release ventilation (APRV) offers an alternative strategy for the management of this patient population. APRV was hypothesized to retard the progression of acute lung/brain injury to a degree greater than ARDSNet in a swine model. Yorkshire swine were randomized to ARDSNet, APRV, or sham. Ventilatory settings and pulmonary parameters, vitals, blood gases, quantitative histopathology, and cerebral microdialysis were compared between groups using χ2, Fisher's exact, Student's t test, Wilcoxon rank-sum, and mixed-effects repeated-measures modeling. Twenty-two swine (17 male, 5 female), weighing a mean (SD) of 25 (6.0) kg, were randomized to APRV (n = 9), ARDSNet (n = 12), or sham (n = 1). PaO2/FIO2 ratio dropped significantly, while intracranial pressure increased significantly for all three groups immediately following lung and brain injury. Over time, peak inspiratory pressure, mean airway ...Continue Reading

References

May 1, 1987·Critical Care Medicine·M C StockD A Frolicher
May 4, 2000·The New England Journal of Medicine·UNKNOWN Acute Respiratory Distress Syndrome NetworkArthur Wheeler
May 4, 2000·The New England Journal of Medicine·L B Ware, M A Matthay
May 14, 2005·Critical Care Medicine·Josefina López-AguilarLluis Blanch
Oct 21, 2005·The New England Journal of Medicine·Gordon D RubenfeldLeonard D Hudson
Jan 6, 2006·Current Opinion in Critical Care·Gregory J Lowe, Niall D Ferguson
Jan 13, 2006·Biometrics·Zhiying Pan, D Y Lin
Nov 24, 2006·The Journal of Head Trauma Rehabilitation·Wesley Rutland-BrownYongli Lily Xi
May 22, 2007·Journal of Neurotrauma·Susan L BrattonDavid W Wright
May 22, 2007·Journal of Neurotrauma·Susan L BrattonDavid W Wright
Jul 16, 2008·American Journal of Physiology. Lung Cellular and Molecular Physiology·Gustavo Matute-BelloThomas R Martin
Mar 28, 2009·Critical Care Medicine·Sara E EricksonUNKNOWN NIH NHLBI ARDS Network
Dec 10, 2009·Current Opinion in Critical Care·Neil YoungPeter J D Andrews
Jan 5, 2011·The Journal of Surgical Research·Scott AlbertGary F Nieman
Aug 2, 2012·The Journal of Clinical Investigation·Michael A MatthayGuy A Zimmerman

❮ Previous
Next ❯

Citations

Dec 12, 2017·International Anesthesiology Clinics·Johann PatlakM Dustin Boone
May 22, 2016·Intensive Care Medicine Experimental·Sumeet V JainNader M Habashi
Dec 24, 2019·Expert Review of Respiratory Medicine·Palen Mallory, Ira Cheifetz
Mar 25, 2019·Experimental and Therapeutic Medicine·Mingxia JiNing Zhang
Sep 26, 2020·Critical Care : the Official Journal of the Critical Care Forum·James E TownerDebra E Roberts
May 20, 2017·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Christopher L JenksLakshmi Raman

❮ Previous
Next ❯

Related Concepts

Related Feeds

Brain Ischemia

Brain ischemia is a condition in which there is insufficient blood flow to the brain to meet metabolic demand. Discover the latest research on brain ischemia here.

Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.