Scanographic comparison of high frequency oscillation with versus without tracheal gas insufflation in acute respiratory distress syndrome.
Intensive Care Med
; 37(6): 990-9, 2011 Jun.
Article
en En
| MEDLINE
| ID: mdl-21369813
PURPOSE: In acute respiratory distress syndrome (ARDS), combined high frequency oscillation (HFO) and tracheal gas insufflation (TGI) improves oxygenation versus standard HFO, likely through TGI-induced lung recruitment. Experimental data suggest that steady flows such as TGI favor the filling of the lower (i.e., subcarinal) lung. We used whole-lung computerized tomography (CT) to determine whether HFO-TGI versus HFO improves the recruitment of the lower lung, and especially of its dependent region, where loss of aeration is maximized in ARDS. METHODS: We enrolled 15 patients who had ARDS for 96 h or less, and pulmonary infiltrates in at least three chest X-ray quadrants. Patients were subjected to whole-lung CT after lung-protective conventional mechanical ventilation (CMV) and after 45 min of HFO and 45 min of HFO-TGI. HFO/HFO-TGI were employed in random order. CT scans were obtained at a continuous positive airways pressure equal to the mean tracheal pressure (P (tr)) of CMV. During HFO/HFO-TGI, mean airway pressure was titrated to the CMV P (tr) level. Gas exchange and intra-arterial pressure/heart rate were determined for each ventilatory technique. RESULTS: Regarding total lung parenchyma, HFO-TGI versus HFO and CMV resulted in a lower percentage of nonaerated lung tissue (mean ± SD, 51.4 ± 5.1% vs. 60.0 ± 2.5%, and 62.1 ± 9.0%, respectively; P≤0.04); this was due to HFO-TGI-induced recruitment of nonaerated tissue in the dependent and nondependent lower lung. HFO-TGI increased normally aerated tissue versus CMV (P=0.04) and poorly aerated tissue versus HFO and CMV (P≤0.04), and improved oxygenation versus HFO and CMV (P≤0.04). CONCLUSIONS: HFO-TGI improves oxygenation versus HFO and CMV through the recruitment of previously nonaerated lower lung units.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Síndrome de Dificultad Respiratoria
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Tráquea
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Ventilación de Alta Frecuencia
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Insuflación
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Tomografía Computarizada por Rayos X
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Pulmón
Límite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Intensive Care Med
Año:
2011
Tipo del documento:
Article
País de afiliación:
Grecia
Pais de publicación:
Estados Unidos