ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure
Purpose To assess whether partitioning the elastance of the respiratory system ( E RS ) between lung ( E L ) and chest wall ( E CW ) elastance in order to target values of end-inspiratory transpulmonary pressure (PPLAT L ) close to its upper physiological limit (25 cmH 2 O) may optimize oxygenation...
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| Veröffentlicht in: | Intensive care medicine 2012-03, Vol.38 (3), p.395-403 |
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| creator | Grasso, Salvatore Terragni, Pierpaolo Birocco, Alberto Urbino, Rosario Del Sorbo, Lorenzo Filippini, Claudia Mascia, Luciana Pesenti, Antonio Zangrillo, Alberto Gattinoni, Luciano Ranieri, V. Marco |
| description | Purpose
To assess whether partitioning the elastance of the respiratory system (
E
RS
) between lung (
E
L
) and chest wall (
E
CW
) elastance in order to target values of end-inspiratory transpulmonary pressure (PPLAT
L
) close to its upper physiological limit (25 cmH
2
O) may optimize oxygenation allowing conventional treatment in patients with influenza A (H1N1)-associated ARDS referred for extracorporeal membrane oxygenation (ECMO).
Methods
Prospective data collection of patients with influenza A (H1N1)-associated ARDS referred for ECMO (October 2009–January 2010). Esophageal pressure was used to (a) partition respiratory mechanics between lung and chest wall, (b) titrate positive end-expiratory pressure (PEEP) to target the upper physiological limit of PPLAT
L
(25 cmH
2
O).
Results
Fourteen patients were referred for ECMO. In seven patients PPLAT
L
was 27.2 ± 1.2 cmH
2
O; all these patients underwent ECMO. In the other seven patients, PPLAT
L
was 16.6 ± 2.9 cmH
2
O. Raising PEEP (from 17.9 ± 1.2 to 22.3 ± 1.4 cmH
2
O,
P
= 0.0001) to approach the upper physiological limit of transpulmonary pressure (PPLAT
L
= 25.3 ± 1.7 cm H
2
O) improved oxygenation index (from 37.4 ± 3.7 to 16.5 ± 1.4,
P
= 0.0001) allowing patients to be treated with conventional ventilation.
Conclusions
Abnormalities of chest wall mechanics may be present in some patients with influenza A (H1N1)-associated ARDS. These abnormalities may not be inferred from measurements of end-inspiratory plateau pressure of the respiratory system (PPLAT
RS
). In these patients, titrating PEEP to PPLAT
RS
may overestimate the incidence of hypoxemia refractory to conventional ventilation leading to inappropriate use of ECMO. |
| doi_str_mv | 10.1007/s00134-012-2490-7 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_954641242</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A724320717</galeid><sourcerecordid>A724320717</sourcerecordid><originalsourceid>FETCH-LOGICAL-c580t-4d09ba1c5659f606d8fc6b3c073347e626087779fde6229594e01a9a6b9064173</originalsourceid><addsrcrecordid>eNqFkl1vFCEUhonR2G31B3hjiMaoF9TDx8Dg3Wat1qTaRO01YRnYTDM7bGHmwv56GWe10awxhEDgeQ-cc16EnlA4pQDqTQagXBCgjDChgah7aEEFZ4QyXt9HC-CCESEFO0LHOV8XWsmKPkRHjHHGQakFujpbfbrELrWDT63FISbc9qEbfX9r8RK_Oqef6Wtic46utYNv8PLLu69vcYqdxzHgIdk-78ZuG3ubvuNd8jmPyT9CD4Ltsn-8X0_Q1fuzb6tzcnH54eNqeUFcVcNARAN6bamrZKWDBNnUwck1d6A4F8pLJqFWSunQlD3TlRYeqNVWrjVIQRU_QS_nuLsUb0afB7Nts_NdZ3sfx2x0VbKnTLD_k4zrqhSTF_LZX-R1HFNf0pggXibUBXo-QxvbeVMqFksl3BTSLBUrLQD183vkALXxvU-2i70PbTn-gz89wJfR-G3rDgroLHAp5px8MLvUbksnDAUzWcTMFjHFImayiJk0T_f5jeutb34rfnmiAC_2gM3OdqG02LX5jivdgkqKwrGZy-Wq3_h0V6h_v_4DB4LM8w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>923392308</pqid></control><display><type>article</type><title>ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Grasso, Salvatore ; Terragni, Pierpaolo ; Birocco, Alberto ; Urbino, Rosario ; Del Sorbo, Lorenzo ; Filippini, Claudia ; Mascia, Luciana ; Pesenti, Antonio ; Zangrillo, Alberto ; Gattinoni, Luciano ; Ranieri, V. Marco</creator><creatorcontrib>Grasso, Salvatore ; Terragni, Pierpaolo ; Birocco, Alberto ; Urbino, Rosario ; Del Sorbo, Lorenzo ; Filippini, Claudia ; Mascia, Luciana ; Pesenti, Antonio ; Zangrillo, Alberto ; Gattinoni, Luciano ; Ranieri, V. Marco</creatorcontrib><description>Purpose
To assess whether partitioning the elastance of the respiratory system (
E
RS
) between lung (
E
L
) and chest wall (
E
CW
) elastance in order to target values of end-inspiratory transpulmonary pressure (PPLAT
L
) close to its upper physiological limit (25 cmH
2
O) may optimize oxygenation allowing conventional treatment in patients with influenza A (H1N1)-associated ARDS referred for extracorporeal membrane oxygenation (ECMO).
Methods
Prospective data collection of patients with influenza A (H1N1)-associated ARDS referred for ECMO (October 2009–January 2010). Esophageal pressure was used to (a) partition respiratory mechanics between lung and chest wall, (b) titrate positive end-expiratory pressure (PEEP) to target the upper physiological limit of PPLAT
L
(25 cmH
2
O).
Results
Fourteen patients were referred for ECMO. In seven patients PPLAT
L
was 27.2 ± 1.2 cmH
2
O; all these patients underwent ECMO. In the other seven patients, PPLAT
L
was 16.6 ± 2.9 cmH
2
O. Raising PEEP (from 17.9 ± 1.2 to 22.3 ± 1.4 cmH
2
O,
P
= 0.0001) to approach the upper physiological limit of transpulmonary pressure (PPLAT
L
= 25.3 ± 1.7 cm H
2
O) improved oxygenation index (from 37.4 ± 3.7 to 16.5 ± 1.4,
P
= 0.0001) allowing patients to be treated with conventional ventilation.
Conclusions
Abnormalities of chest wall mechanics may be present in some patients with influenza A (H1N1)-associated ARDS. These abnormalities may not be inferred from measurements of end-inspiratory plateau pressure of the respiratory system (PPLAT
RS
). In these patients, titrating PEEP to PPLAT
RS
may overestimate the incidence of hypoxemia refractory to conventional ventilation leading to inappropriate use of ECMO.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-012-2490-7</identifier><identifier>PMID: 22323077</identifier><identifier>CODEN: ICMED9</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anesthesiology ; Biological and medical sciences ; Care and treatment ; Chest ; Critical Care Medicine ; Data collection ; Data collections ; Emergency and intensive respiratory care ; Emergency Medicine ; Esophagus ; Extracorporeal membrane oxygenation ; Extracorporeal Membrane Oxygenation - standards ; Humans ; Hypoxemia ; Influenza ; Influenza A ; Influenza A Virus, H1N1 Subtype ; Influenza, Human - complications ; Influenza, Human - therapy ; Intensive ; Intensive care medicine ; Italy ; Lung ; Mechanics ; Medical sciences ; Medicine ; Medicine & Public Health ; Original ; Pain Medicine ; Pediatrics ; Physiological aspects ; Physiology ; Pneumology/Respiratory System ; Positive-Pressure Respiration - methods ; Positive-Pressure Respiration - standards ; Pressure ; Respiratory Distress Syndrome, Adult - etiology ; Respiratory Distress Syndrome, Adult - therapy ; Respiratory system ; Ventilation ; Ventilators</subject><ispartof>Intensive care medicine, 2012-03, Vol.38 (3), p.395-403</ispartof><rights>Copyright jointly held by Springer and ESICM 2012</rights><rights>2015 INIST-CNRS</rights><rights>COPYRIGHT 2012 Springer</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c580t-4d09ba1c5659f606d8fc6b3c073347e626087779fde6229594e01a9a6b9064173</citedby><cites>FETCH-LOGICAL-c580t-4d09ba1c5659f606d8fc6b3c073347e626087779fde6229594e01a9a6b9064173</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-012-2490-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-012-2490-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,782,786,27931,27932,41495,42564,51326</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25650564$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22323077$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Grasso, Salvatore</creatorcontrib><creatorcontrib>Terragni, Pierpaolo</creatorcontrib><creatorcontrib>Birocco, Alberto</creatorcontrib><creatorcontrib>Urbino, Rosario</creatorcontrib><creatorcontrib>Del Sorbo, Lorenzo</creatorcontrib><creatorcontrib>Filippini, Claudia</creatorcontrib><creatorcontrib>Mascia, Luciana</creatorcontrib><creatorcontrib>Pesenti, Antonio</creatorcontrib><creatorcontrib>Zangrillo, Alberto</creatorcontrib><creatorcontrib>Gattinoni, Luciano</creatorcontrib><creatorcontrib>Ranieri, V. Marco</creatorcontrib><title>ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>Purpose
To assess whether partitioning the elastance of the respiratory system (
E
RS
) between lung (
E
L
) and chest wall (
E
CW
) elastance in order to target values of end-inspiratory transpulmonary pressure (PPLAT
L
) close to its upper physiological limit (25 cmH
2
O) may optimize oxygenation allowing conventional treatment in patients with influenza A (H1N1)-associated ARDS referred for extracorporeal membrane oxygenation (ECMO).
Methods
Prospective data collection of patients with influenza A (H1N1)-associated ARDS referred for ECMO (October 2009–January 2010). Esophageal pressure was used to (a) partition respiratory mechanics between lung and chest wall, (b) titrate positive end-expiratory pressure (PEEP) to target the upper physiological limit of PPLAT
L
(25 cmH
2
O).
Results
Fourteen patients were referred for ECMO. In seven patients PPLAT
L
was 27.2 ± 1.2 cmH
2
O; all these patients underwent ECMO. In the other seven patients, PPLAT
L
was 16.6 ± 2.9 cmH
2
O. Raising PEEP (from 17.9 ± 1.2 to 22.3 ± 1.4 cmH
2
O,
P
= 0.0001) to approach the upper physiological limit of transpulmonary pressure (PPLAT
L
= 25.3 ± 1.7 cm H
2
O) improved oxygenation index (from 37.4 ± 3.7 to 16.5 ± 1.4,
P
= 0.0001) allowing patients to be treated with conventional ventilation.
Conclusions
Abnormalities of chest wall mechanics may be present in some patients with influenza A (H1N1)-associated ARDS. These abnormalities may not be inferred from measurements of end-inspiratory plateau pressure of the respiratory system (PPLAT
RS
). In these patients, titrating PEEP to PPLAT
RS
may overestimate the incidence of hypoxemia refractory to conventional ventilation leading to inappropriate use of ECMO.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anesthesiology</subject><subject>Biological and medical sciences</subject><subject>Care and treatment</subject><subject>Chest</subject><subject>Critical Care Medicine</subject><subject>Data collection</subject><subject>Data collections</subject><subject>Emergency and intensive respiratory care</subject><subject>Emergency Medicine</subject><subject>Esophagus</subject><subject>Extracorporeal membrane oxygenation</subject><subject>Extracorporeal Membrane Oxygenation - standards</subject><subject>Humans</subject><subject>Hypoxemia</subject><subject>Influenza</subject><subject>Influenza A</subject><subject>Influenza A Virus, H1N1 Subtype</subject><subject>Influenza, Human - complications</subject><subject>Influenza, Human - therapy</subject><subject>Intensive</subject><subject>Intensive care medicine</subject><subject>Italy</subject><subject>Lung</subject><subject>Mechanics</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original</subject><subject>Pain Medicine</subject><subject>Pediatrics</subject><subject>Physiological aspects</subject><subject>Physiology</subject><subject>Pneumology/Respiratory System</subject><subject>Positive-Pressure Respiration - methods</subject><subject>Positive-Pressure Respiration - standards</subject><subject>Pressure</subject><subject>Respiratory Distress Syndrome, Adult - etiology</subject><subject>Respiratory Distress Syndrome, Adult - therapy</subject><subject>Respiratory system</subject><subject>Ventilation</subject><subject>Ventilators</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkl1vFCEUhonR2G31B3hjiMaoF9TDx8Dg3Wat1qTaRO01YRnYTDM7bGHmwv56GWe10awxhEDgeQ-cc16EnlA4pQDqTQagXBCgjDChgah7aEEFZ4QyXt9HC-CCESEFO0LHOV8XWsmKPkRHjHHGQakFujpbfbrELrWDT63FISbc9qEbfX9r8RK_Oqef6Wtic46utYNv8PLLu69vcYqdxzHgIdk-78ZuG3ubvuNd8jmPyT9CD4Ltsn-8X0_Q1fuzb6tzcnH54eNqeUFcVcNARAN6bamrZKWDBNnUwck1d6A4F8pLJqFWSunQlD3TlRYeqNVWrjVIQRU_QS_nuLsUb0afB7Nts_NdZ3sfx2x0VbKnTLD_k4zrqhSTF_LZX-R1HFNf0pggXibUBXo-QxvbeVMqFksl3BTSLBUrLQD183vkALXxvU-2i70PbTn-gz89wJfR-G3rDgroLHAp5px8MLvUbksnDAUzWcTMFjHFImayiJk0T_f5jeutb34rfnmiAC_2gM3OdqG02LX5jivdgkqKwrGZy-Wq3_h0V6h_v_4DB4LM8w</recordid><startdate>20120301</startdate><enddate>20120301</enddate><creator>Grasso, Salvatore</creator><creator>Terragni, Pierpaolo</creator><creator>Birocco, Alberto</creator><creator>Urbino, Rosario</creator><creator>Del Sorbo, Lorenzo</creator><creator>Filippini, Claudia</creator><creator>Mascia, Luciana</creator><creator>Pesenti, Antonio</creator><creator>Zangrillo, Alberto</creator><creator>Gattinoni, Luciano</creator><creator>Ranieri, V. Marco</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>7U9</scope><scope>H94</scope></search><sort><creationdate>20120301</creationdate><title>ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure</title><author>Grasso, Salvatore ; Terragni, Pierpaolo ; Birocco, Alberto ; Urbino, Rosario ; Del Sorbo, Lorenzo ; Filippini, Claudia ; Mascia, Luciana ; Pesenti, Antonio ; Zangrillo, Alberto ; Gattinoni, Luciano ; Ranieri, V. Marco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c580t-4d09ba1c5659f606d8fc6b3c073347e626087779fde6229594e01a9a6b9064173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anesthesiology</topic><topic>Biological and medical sciences</topic><topic>Care and treatment</topic><topic>Chest</topic><topic>Critical Care Medicine</topic><topic>Data collection</topic><topic>Data collections</topic><topic>Emergency and intensive respiratory care</topic><topic>Emergency Medicine</topic><topic>Esophagus</topic><topic>Extracorporeal membrane oxygenation</topic><topic>Extracorporeal Membrane Oxygenation - standards</topic><topic>Humans</topic><topic>Hypoxemia</topic><topic>Influenza</topic><topic>Influenza A</topic><topic>Influenza A Virus, H1N1 Subtype</topic><topic>Influenza, Human - complications</topic><topic>Influenza, Human - therapy</topic><topic>Intensive</topic><topic>Intensive care medicine</topic><topic>Italy</topic><topic>Lung</topic><topic>Mechanics</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original</topic><topic>Pain Medicine</topic><topic>Pediatrics</topic><topic>Physiological aspects</topic><topic>Physiology</topic><topic>Pneumology/Respiratory System</topic><topic>Positive-Pressure Respiration - methods</topic><topic>Positive-Pressure Respiration - standards</topic><topic>Pressure</topic><topic>Respiratory Distress Syndrome, Adult - etiology</topic><topic>Respiratory Distress Syndrome, Adult - therapy</topic><topic>Respiratory system</topic><topic>Ventilation</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Grasso, Salvatore</creatorcontrib><creatorcontrib>Terragni, Pierpaolo</creatorcontrib><creatorcontrib>Birocco, Alberto</creatorcontrib><creatorcontrib>Urbino, Rosario</creatorcontrib><creatorcontrib>Del Sorbo, Lorenzo</creatorcontrib><creatorcontrib>Filippini, Claudia</creatorcontrib><creatorcontrib>Mascia, Luciana</creatorcontrib><creatorcontrib>Pesenti, Antonio</creatorcontrib><creatorcontrib>Zangrillo, Alberto</creatorcontrib><creatorcontrib>Gattinoni, Luciano</creatorcontrib><creatorcontrib>Ranieri, V. Marco</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Grasso, Salvatore</au><au>Terragni, Pierpaolo</au><au>Birocco, Alberto</au><au>Urbino, Rosario</au><au>Del Sorbo, Lorenzo</au><au>Filippini, Claudia</au><au>Mascia, Luciana</au><au>Pesenti, Antonio</au><au>Zangrillo, Alberto</au><au>Gattinoni, Luciano</au><au>Ranieri, V. Marco</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2012-03-01</date><risdate>2012</risdate><volume>38</volume><issue>3</issue><spage>395</spage><epage>403</epage><pages>395-403</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><coden>ICMED9</coden><abstract>Purpose
To assess whether partitioning the elastance of the respiratory system (
E
RS
) between lung (
E
L
) and chest wall (
E
CW
) elastance in order to target values of end-inspiratory transpulmonary pressure (PPLAT
L
) close to its upper physiological limit (25 cmH
2
O) may optimize oxygenation allowing conventional treatment in patients with influenza A (H1N1)-associated ARDS referred for extracorporeal membrane oxygenation (ECMO).
Methods
Prospective data collection of patients with influenza A (H1N1)-associated ARDS referred for ECMO (October 2009–January 2010). Esophageal pressure was used to (a) partition respiratory mechanics between lung and chest wall, (b) titrate positive end-expiratory pressure (PEEP) to target the upper physiological limit of PPLAT
L
(25 cmH
2
O).
Results
Fourteen patients were referred for ECMO. In seven patients PPLAT
L
was 27.2 ± 1.2 cmH
2
O; all these patients underwent ECMO. In the other seven patients, PPLAT
L
was 16.6 ± 2.9 cmH
2
O. Raising PEEP (from 17.9 ± 1.2 to 22.3 ± 1.4 cmH
2
O,
P
= 0.0001) to approach the upper physiological limit of transpulmonary pressure (PPLAT
L
= 25.3 ± 1.7 cm H
2
O) improved oxygenation index (from 37.4 ± 3.7 to 16.5 ± 1.4,
P
= 0.0001) allowing patients to be treated with conventional ventilation.
Conclusions
Abnormalities of chest wall mechanics may be present in some patients with influenza A (H1N1)-associated ARDS. These abnormalities may not be inferred from measurements of end-inspiratory plateau pressure of the respiratory system (PPLAT
RS
). In these patients, titrating PEEP to PPLAT
RS
may overestimate the incidence of hypoxemia refractory to conventional ventilation leading to inappropriate use of ECMO.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>22323077</pmid><doi>10.1007/s00134-012-2490-7</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0342-4642 |
| ispartof | Intensive care medicine, 2012-03, Vol.38 (3), p.395-403 |
| issn | 0342-4642 1432-1238 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_954641242 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthesiology Biological and medical sciences Care and treatment Chest Critical Care Medicine Data collection Data collections Emergency and intensive respiratory care Emergency Medicine Esophagus Extracorporeal membrane oxygenation Extracorporeal Membrane Oxygenation - standards Humans Hypoxemia Influenza Influenza A Influenza A Virus, H1N1 Subtype Influenza, Human - complications Influenza, Human - therapy Intensive Intensive care medicine Italy Lung Mechanics Medical sciences Medicine Medicine & Public Health Original Pain Medicine Pediatrics Physiological aspects Physiology Pneumology/Respiratory System Positive-Pressure Respiration - methods Positive-Pressure Respiration - standards Pressure Respiratory Distress Syndrome, Adult - etiology Respiratory Distress Syndrome, Adult - therapy Respiratory system Ventilation Ventilators |
| title | ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-04T09%3A01%3A50IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=ECMO%20criteria%20for%20influenza%20A%20(H1N1)-associated%20ARDS:%20role%20of%20transpulmonary%20pressure&rft.jtitle=Intensive%20care%20medicine&rft.au=Grasso,%20Salvatore&rft.date=2012-03-01&rft.volume=38&rft.issue=3&rft.spage=395&rft.epage=403&rft.pages=395-403&rft.issn=0342-4642&rft.eissn=1432-1238&rft.coden=ICMED9&rft_id=info:doi/10.1007/s00134-012-2490-7&rft_dat=%3Cgale_proqu%3EA724320717%3C/gale_proqu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=923392308&rft_id=info:pmid/22323077&rft_galeid=A724320717&rfr_iscdi=true |