Physiological effects of an open lung ventilatory strategy titrated on elastance-derived end-inspiratory transpulmonary pressure: study in a pig model*

Critical Care Medicine
Francesco StaffieriSalvatore Grasso

Abstract

In the presence of increased chest wall elastance, the airway pressure does not reflect the lung-distending (transpulmonary) pressure. To compare the physiological effects of a conventional open lung approach titrated for an end-inspiratory airway opening plateau pressure (30 cm H2O) with a transpulmonary open lung approach titrated for a elastance-derived end-inspiratory plateau transpulmonary pressure (26 cm H2O), in a pig model of acute respiratory distress syndrome (HCl inhalation) and reversible chest wall mechanical impairment (chest wall and abdomen restriction). In eight pigs, physiological parameters and computed tomography were recorded under three conditions: 1) conventional open lung approach, normal chest wall; 2) conventional open lung approach, stiff chest wall; and 3) transpulmonary open lung approach, stiff chest wall. As compared with the normal chest wall condition, at end-expiration non aerated lung tissue weight was increased by 116 ± 68 % during the conventional open lung approach and by 28 ± 41 % during the transpulmonary open lung approach (p < .01), whereas cardiac output was decreased by 27 ± 19 % and 22 ± 14 %, respectively (p = not significant). In this model, the end-inspiratory transpulmonary open ...Continue Reading

References

Dec 1, 1990·Journal of Applied Physiology·M TakataJ L Robotham
May 1, 1989·Journal of Applied Physiology·L A HernandezJ C Parker
Jun 1, 1985·Journal of Applied Physiology·S N HussainR L Pardy
Jun 1, 1985·Journal of Applied Physiology·S N Hussain, R L Pardy
Jan 1, 1994·American Journal of Respiratory and Critical Care Medicine·V M RanieriJ Milic-Emili
May 20, 1998·Critical Care Medicine·C RosenthalM Sagy
Mar 1, 1964·Journal of Applied Physiology·J MILIC-EMILIE M GLAUSER
Mar 1, 1964·Journal of Applied Physiology·J MILIC-EMILIJ M TURNER
Dec 13, 2003·American Journal of Respiratory and Critical Care Medicine·Michael QuintelLuciano Gattinoni
Jul 23, 2004·The New England Journal of Medicine·Roy G BrowerUNKNOWN National Heart, Lung, and Blood Institute ARDS Clinical Trials Network
Oct 8, 2004·Critical Care : the Official Journal of the Critical Care Forum·Luciano GattinoniFranco Valenza
Jan 25, 2005·American Journal of Respiratory and Critical Care Medicine·Salvatore GrassoTommaso Fiore
Dec 17, 2005·Critical Care : the Official Journal of the Critical Care Forum·Thomas Luecke, Paolo Pelosi
Mar 17, 2006·Critical Care Medicine·Daniel TalmorStephen H Loring
Apr 25, 2006·Critical Care Medicine·David N Hager, Roy G Brower
May 13, 2006·American Journal of Respiratory and Critical Care Medicine·João B BorgesMarcelo B P Amato
Aug 26, 2006·Critical Care Medicine·Dinis Reis MirandaDiederik Gommers
Oct 14, 2006·American Journal of Respiratory and Critical Care Medicine·Pier Paolo TerragniV Marco Ranieri
Nov 18, 2006·Critical Care Medicine·Fernando Suarez-SipmannGöran Hedenstierna
Jul 28, 2007·American Journal of Respiratory and Critical Care Medicine·Salvatore GrassoTommaso Fiore
Jan 16, 2008·Current Opinion in Critical Care·Dean R Hess, Luca M Bigatello
Feb 14, 2008·JAMA : the Journal of the American Medical Association·Alain MercatUNKNOWN Expiratory Pressure (Express) Study Group
May 3, 2008·American Journal of Respiratory and Critical Care Medicine·Davide ChiumelloLuciano Gattinoni
May 10, 2008·Current Opinion in Critical Care·Patrick MorganAndrew Rhodes
Nov 13, 2008·The New England Journal of Medicine·Daniel TalmorStephen H Loring
Jun 23, 2009·American Journal of Respiratory and Critical Care Medicine·Salvatore GrassoTommaso Fiore
Nov 17, 2009·American Journal of Respiratory and Critical Care Medicine·Pietro CaironiLuciano Gattinoni
Dec 29, 2009·The Journal of Surgical Research·Brian D KubiakGary F Nieman
May 6, 2010·Chest·Adebayo EsanCurtis N Sessler
Jul 6, 2010·Critical Care : the Official Journal of the Critical Care Forum·Adrian RegliPeter V van Heerden
Mar 3, 2011·Intensive Care Medicine·D ChiumelloL Gattinoni
Feb 11, 2012·Intensive Care Medicine·Salvatore GrassoV Marco Ranieri

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Citations

Dec 22, 2012·Critical Care : the Official Journal of the Critical Care Forum·Paolo Pelosi, Maria Vargas
Jan 29, 2014·American Journal of Respiratory and Critical Care Medicine·Evangelia AkoumianakiLaurent Brochard
Aug 13, 2014·Intensive Care Medicine·Davide ChiumelloLuciano Gattinoni
Dec 24, 2015·Intensive Care Medicine Experimental·Michaela Kollisch-SinguleNader M Habashi
Dec 18, 2015·British Journal of Anaesthesia·D ChiumelloL Gattinoni
Jan 20, 2015·Critical Care Medicine·Stephen H Loring, Daniel Talmor
Oct 2, 2015·Transplantation·Pier Paolo TerragniV Marco Ranieri
Sep 9, 2016·American Journal of Respiratory and Critical Care Medicine·Stephen H LoringRolf D Hubmayr
Mar 31, 2018·Current Opinion in Critical Care·Takeshi Yoshida, Laurent Brochard
Mar 3, 2015·European Respiratory Review : an Official Journal of the European Respiratory Society·Nuttapol Rittayamai, Laurent Brochard
Dec 28, 2012·Critical Care Medicine·Pablo O RodriguezRicardo Valentini
Dec 28, 2012·Critical Care Medicine·Daniel S Talmor, Stephen H Loring
Dec 28, 2012·Critical Care Medicine·Salvatore GrassoTania Stripoli
Dec 28, 2012·Critical Care Medicine·Antonio PesentiTommaso Mauri
Jul 18, 2019·Annals of Intensive Care·Marie BergezHadrien Rozé
Jan 13, 2018·American Journal of Respiratory and Critical Care Medicine·Takeshi YoshidaBrian P Kavanagh
Mar 7, 2018·American Journal of Respiratory and Critical Care Medicine·Salvatore Grasso, Tania Stripoli
May 17, 2019·Anesthesiology·Elizabeth C WilliamsMarcos F Vidal Melo
Sep 3, 2020·American Journal of Respiratory and Critical Care Medicine·Roberta De Santis SantiagoUNKNOWN Lung Rescue Team Investigators

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