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Effects of a low tidal volume ventilation strategy on the pressure/volume curve in ALI/ARDS patients

To evaluate, in ARDS/ALI patients ventilated with a low tidal volume and PEEP, according to the NIH network trial [1], the effects on the parameters of the pressure/volume (PV) curve of the respiratory system.

Four ARDS/ALI sedated and paralyzed patients (age 62 ± 24 years, weight 66 ± 10 kg, PaO2/FiO2 216 ± 70 mmHg, PEEP 12.7 ± 2.2 cmH2O) were studied. P/V curves were performed at the beginning and after 120 min with the supersyringe technique. A recruitment maneuver was performed at the beginning of the study. Chest wall volume was measured by the optoelectronic plethysmography technique. Lower and upper inflection points (Pcl, Pcu), maximal compliance (Cmax) and vital capacity (VC) on the inflation limb were computed according to Venegas' analysis [2]. Compliance at 100 ml (C0.1), inflation compliance (Cinf), percentage hysteresis (Hyst%) and unrecovered volume (UV) were calculated using standard formulas [3]. In Table 1, the results are expressed as mean ± SD. These data suggest that after 2 hour ventilation with a low tidal volume strategy there are no major modifications in the P/V curve parameters.

Table 1

References

  1. The Acute Respiratory Distress Syndrome Network: Ventilation. N Engl J Med 2000, 342: 1301-1308. 10.1056/NEJM200005043421801

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  3. Gattinoni L, et al.: Intensive Care Med 1987, 13: 19-25. 10.1007/BF00263552

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Chiumello, D., Carlesso, E., Storelli, E. et al. Effects of a low tidal volume ventilation strategy on the pressure/volume curve in ALI/ARDS patients. Crit Care 7, P164 (2003). https://doi.org/10.1186/cc2053

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  • DOI: https://doi.org/10.1186/cc2053

Keywords

  • Vital Capacity
  • Ventilation Strategy
  • Recruitment Maneuver
  • Volume Strategy
  • Volume Ventilation