Abstract
Lung volume recruitment maneuvers (RMs) are a potential adjunct to protective ventilation for acure respiratory distress syndrome patients. However, data demonstrating improvement in important outcomes such as lung injury severity and mortality are lacking. We hypothesized that RMs reduce lung endothelial and alveolar epithelial injury in a clinically relevant rat model of acid-induced lung injury. Compared with a protective ventilation strategy without RMs, sustained inflation RMs (30 cmH2O) every 30 min significantly improved oxygenation, lung volume, dead space fraction, and compliance. RMs reduced extravascular lung water (P < 0.05). RMs also reduced lung endothelial protein permeability (217 ± 28 vs 314 ± 70 extravascular plasma equivalents, P < 0.05). However, RMs did not prevent alveolar epithelial injury. Epithelial permeability and BAL RTI40 levels, a previously validated and specific marker of type I cell injury, were similar with or without RMs. RMs also decreased epithelial fluid transport, a functional marker of epithelial injury (Fig. (Fig.1;1; *P < 0.05 vs no injury, †P < 0.05 vs no RM). There was a trend toward lower systemic blood pressure and cardiac output in the group receiving RMs. RMs did not reduce markers of airspace inflammation. In conclusion, frequent RMs improved gas exchange, and reduced lung water in part through effects on hemodynamics. RMs may protect the lung endothelium, but do not reduce alveolar epithelial injury. Because alveolar epithelial injury is associated with lung injury severity and mortality, these data suggest that RMs may not improve these patient outcomes. Figure 1
Highlights
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today
Summary Our study demonstrated that LS is a good alternative to restore cardiac contractile function when combined with NE
The use of AVP may lead to further deteriorate sepsis-related myocardial dysfunction even when combined with a positive inotropic agent
Summary
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today. The objectives of the current study were (1) to assess the prognostic significance of plasma concentrations of NSE for early prediction of outcome in patients at risk for anoxic encephalopathy after cardiopulmonary resuscitation (CPR), and (2) to compare the prognostic information provided by NSE measurements with that provided by conventional risk indicators (clinical neurological examination and computerised tomography [CT] scan of the brain). Independent pulmonary ventilation was introduced in the 1930s and allows the utilization of different ventilatory strategies for each lung to improve gas exchange, respiratory mechanics or both in patients with heterogeneous lung diseases It is not clear whether the lower inflection point (LIP) on the inspiratory limb or the point of maximum curvature (PMC) on the deflation limb of the pressure–volume (PV) curve should be used for the positive end-expiratory pressure (PEEP) setting in acute lung injury (ALI). The long-term outcome, health-related quality of life (HRQL), and ICU and hospital costs of medical ICU patients were assessed
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