Efficacy of positive end-expiratory pressure titration after the alveolar recruitment manoeuvre in patients with acute respiratory distress syndrome
In acute respiratory distress syndrome (ARDS), adequate positive end-expiratory pressure (PEEP) may decrease ventilator-induced lung injury by minimising overinflation and cyclic recruitment-derecruitment of the lung. We evaluated whether setting the PEEP using decremental PEEP titration after an al...
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| creator | Huh, Jin Won Jung, Hoon Choi, Hye Sook Hong, Sang-Bum Lim, Chae-Man Koh, Younsuck |
| description | In acute respiratory distress syndrome (ARDS), adequate positive end-expiratory pressure (PEEP) may decrease ventilator-induced lung injury by minimising overinflation and cyclic recruitment-derecruitment of the lung. We evaluated whether setting the PEEP using decremental PEEP titration after an alveolar recruitment manoeuvre (ARM) affects the clinical outcome in patients with ARDS.
Fifty-seven patients with early ARDS were randomly assigned to a group given decremental PEEP titration following ARM or a table-based PEEP (control) group. PEEP and inspired fraction of oxygen (FiO2) in the control group were set according to the table-based combinations of FiO2 and PEEP of the ARDS network, by which we aimed to achieve a PEEP level compatible with an oxygenation target. In the decremental PEEP titration group, the oxygen saturation and static compliance were monitored as the patients performed the ARM along with the extended sigh method, which is designed to gradually apply and withdraw a high distending pressure over a prolonged period, and the decremental titration of PEEP.
The baseline characteristics did not differ significantly between the control and decremental PEEP titration groups. Initial oxygenation improved more in the decremental PEEP titration group than in the control group. However, dynamic compliance, tidal volume and PEEP were similar in the two groups during the first week. The duration of use of paralysing or sedative agents, mechanical ventilation, stay in the intensive care unit and mortality at 28 days did not differ significantly between the decremental PEEP titration and control groups.
The daily decremental PEEP titration after ARM showed only initial oxygenation improvement compared with the table-based PEEP method. Respiratory mechanics and patient outcomes did not differ between the decremental PEEP titration and control groups.
ClinicalTrials.gov identifier: ISRCTN79027921. |
| doi_str_mv | 10.1186/cc7725 |
| format | Article |
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Fifty-seven patients with early ARDS were randomly assigned to a group given decremental PEEP titration following ARM or a table-based PEEP (control) group. PEEP and inspired fraction of oxygen (FiO2) in the control group were set according to the table-based combinations of FiO2 and PEEP of the ARDS network, by which we aimed to achieve a PEEP level compatible with an oxygenation target. In the decremental PEEP titration group, the oxygen saturation and static compliance were monitored as the patients performed the ARM along with the extended sigh method, which is designed to gradually apply and withdraw a high distending pressure over a prolonged period, and the decremental titration of PEEP.
The baseline characteristics did not differ significantly between the control and decremental PEEP titration groups. Initial oxygenation improved more in the decremental PEEP titration group than in the control group. However, dynamic compliance, tidal volume and PEEP were similar in the two groups during the first week. The duration of use of paralysing or sedative agents, mechanical ventilation, stay in the intensive care unit and mortality at 28 days did not differ significantly between the decremental PEEP titration and control groups.
The daily decremental PEEP titration after ARM showed only initial oxygenation improvement compared with the table-based PEEP method. Respiratory mechanics and patient outcomes did not differ between the decremental PEEP titration and control groups.
ClinicalTrials.gov identifier: ISRCTN79027921.</description><identifier>ISSN: 1364-8535</identifier><identifier>EISSN: 1466-609X</identifier><identifier>EISSN: 1364-8535</identifier><identifier>DOI: 10.1186/cc7725</identifier><identifier>PMID: 19239703</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Acute respiratory distress syndrome ; Artificial respiration ; Care and treatment ; Diagnosis ; Female ; Health aspects ; Humans ; Male ; Middle Aged ; Patient outcomes ; Physiological aspects ; Positive-Pressure Respiration - methods ; Pulmonary Alveoli - physiology ; Respiratory Distress Syndrome, Adult - physiopathology ; Respiratory Distress Syndrome, Adult - therapy ; Respiratory Mechanics - physiology ; Respiratory physiology ; Titrimetry - methods</subject><ispartof>Critical care (London, England), 2009-01, Vol.13 (1), p.R22-R22, Article R22</ispartof><rights>COPYRIGHT 2009 BioMed Central Ltd.</rights><rights>Copyright National Library of Medicine - MEDLINE Abstracts 2009</rights><rights>Copyright © 2009 Huh et al.; licensee BioMed Central Ltd. 2009 Huh et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b481t-310e0e9c7d8c430a6fbd7b9cbed555ed0f55f076361b48e0d4f6e6ca277a28b43</citedby><cites>FETCH-LOGICAL-b481t-310e0e9c7d8c430a6fbd7b9cbed555ed0f55f076361b48e0d4f6e6ca277a28b43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2688140/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2688140/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19239703$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huh, Jin Won</creatorcontrib><creatorcontrib>Jung, Hoon</creatorcontrib><creatorcontrib>Choi, Hye Sook</creatorcontrib><creatorcontrib>Hong, Sang-Bum</creatorcontrib><creatorcontrib>Lim, Chae-Man</creatorcontrib><creatorcontrib>Koh, Younsuck</creatorcontrib><title>Efficacy of positive end-expiratory pressure titration after the alveolar recruitment manoeuvre in patients with acute respiratory distress syndrome</title><title>Critical care (London, England)</title><addtitle>Crit Care</addtitle><description>In acute respiratory distress syndrome (ARDS), adequate positive end-expiratory pressure (PEEP) may decrease ventilator-induced lung injury by minimising overinflation and cyclic recruitment-derecruitment of the lung. We evaluated whether setting the PEEP using decremental PEEP titration after an alveolar recruitment manoeuvre (ARM) affects the clinical outcome in patients with ARDS.
Fifty-seven patients with early ARDS were randomly assigned to a group given decremental PEEP titration following ARM or a table-based PEEP (control) group. PEEP and inspired fraction of oxygen (FiO2) in the control group were set according to the table-based combinations of FiO2 and PEEP of the ARDS network, by which we aimed to achieve a PEEP level compatible with an oxygenation target. In the decremental PEEP titration group, the oxygen saturation and static compliance were monitored as the patients performed the ARM along with the extended sigh method, which is designed to gradually apply and withdraw a high distending pressure over a prolonged period, and the decremental titration of PEEP.
The baseline characteristics did not differ significantly between the control and decremental PEEP titration groups. Initial oxygenation improved more in the decremental PEEP titration group than in the control group. However, dynamic compliance, tidal volume and PEEP were similar in the two groups during the first week. The duration of use of paralysing or sedative agents, mechanical ventilation, stay in the intensive care unit and mortality at 28 days did not differ significantly between the decremental PEEP titration and control groups.
The daily decremental PEEP titration after ARM showed only initial oxygenation improvement compared with the table-based PEEP method. Respiratory mechanics and patient outcomes did not differ between the decremental PEEP titration and control groups.
ClinicalTrials.gov identifier: ISRCTN79027921.</description><subject>Acute respiratory distress syndrome</subject><subject>Artificial respiration</subject><subject>Care and treatment</subject><subject>Diagnosis</subject><subject>Female</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patient outcomes</subject><subject>Physiological aspects</subject><subject>Positive-Pressure Respiration - methods</subject><subject>Pulmonary Alveoli - physiology</subject><subject>Respiratory Distress Syndrome, Adult - physiopathology</subject><subject>Respiratory Distress Syndrome, Adult - therapy</subject><subject>Respiratory Mechanics - physiology</subject><subject>Respiratory physiology</subject><subject>Titrimetry - methods</subject><issn>1364-8535</issn><issn>1466-609X</issn><issn>1364-8535</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1Us1u1DAQjhCIlgKPgCwO5ZRix7GdXJCqqvxIlXopEjfLscddV4kdbGdh36MPjFdZtRSJk62Z708zU1VvCT4jpOMftRaiYc-qY9JyXnPc_3he_pS3dccoO6pepXSHMREdpy-rI9I3tBeYHlf3l9Y6rfQOBYvmkFx2W0DgTQ2_ZxdVDnGH5ggpLRFQdrmUXPBI2QwR5Q0gNW4hjCqiCDouLk_gM5qUD7BsC8V5NBdKKSb0y-UNUnrJUMDpQd64lPcOKO28iWGC19ULq8YEbw7vSfX98-XNxdf66vrLt4vzq3poO5JrSjBg6LUwnW4pVtwORgy9HsAwxsBgy5jFglNOCgGwaS0HrlUjhGq6oaUn1adVd16GCYwuIaMa5RzdpOJOBuXk0453G3kbtrLhXUdaXAT6VWBw4T8CTzs6THJdVeF-OJjH8HOBlOXkkoZxVB7CkqSgtCE9Ibwg3_-DvAtL9GUykvSsZRyTfZSzFXSrRpDO21AMy2KVgcnp4MG6Uj8vBCqatqeFcLoSdAwpRbAPsQmW-5t6DPru7yk9wg5HRP8AHbfOMQ</recordid><startdate>20090101</startdate><enddate>20090101</enddate><creator>Huh, Jin Won</creator><creator>Jung, Hoon</creator><creator>Choi, Hye Sook</creator><creator>Hong, Sang-Bum</creator><creator>Lim, Chae-Man</creator><creator>Koh, Younsuck</creator><general>BioMed Central Ltd</general><general>National Library of Medicine - MEDLINE Abstracts</general><general>BioMed Central</general><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>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20090101</creationdate><title>Efficacy of positive end-expiratory pressure titration after the alveolar recruitment manoeuvre in patients with acute respiratory distress syndrome</title><author>Huh, Jin Won ; Jung, Hoon ; Choi, Hye Sook ; Hong, Sang-Bum ; Lim, Chae-Man ; Koh, Younsuck</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b481t-310e0e9c7d8c430a6fbd7b9cbed555ed0f55f076361b48e0d4f6e6ca277a28b43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Acute respiratory distress syndrome</topic><topic>Artificial respiration</topic><topic>Care and treatment</topic><topic>Diagnosis</topic><topic>Female</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patient outcomes</topic><topic>Physiological aspects</topic><topic>Positive-Pressure Respiration - methods</topic><topic>Pulmonary Alveoli - physiology</topic><topic>Respiratory Distress Syndrome, Adult - physiopathology</topic><topic>Respiratory Distress Syndrome, Adult - therapy</topic><topic>Respiratory Mechanics - physiology</topic><topic>Respiratory physiology</topic><topic>Titrimetry - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huh, Jin Won</creatorcontrib><creatorcontrib>Jung, Hoon</creatorcontrib><creatorcontrib>Choi, Hye Sook</creatorcontrib><creatorcontrib>Hong, Sang-Bum</creatorcontrib><creatorcontrib>Lim, Chae-Man</creatorcontrib><creatorcontrib>Koh, Younsuck</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Critical care (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huh, Jin Won</au><au>Jung, Hoon</au><au>Choi, Hye Sook</au><au>Hong, Sang-Bum</au><au>Lim, Chae-Man</au><au>Koh, Younsuck</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy of positive end-expiratory pressure titration after the alveolar recruitment manoeuvre in patients with acute respiratory distress syndrome</atitle><jtitle>Critical care (London, England)</jtitle><addtitle>Crit Care</addtitle><date>2009-01-01</date><risdate>2009</risdate><volume>13</volume><issue>1</issue><spage>R22</spage><epage>R22</epage><pages>R22-R22</pages><artnum>R22</artnum><issn>1364-8535</issn><eissn>1466-609X</eissn><eissn>1364-8535</eissn><abstract>In acute respiratory distress syndrome (ARDS), adequate positive end-expiratory pressure (PEEP) may decrease ventilator-induced lung injury by minimising overinflation and cyclic recruitment-derecruitment of the lung. We evaluated whether setting the PEEP using decremental PEEP titration after an alveolar recruitment manoeuvre (ARM) affects the clinical outcome in patients with ARDS.
Fifty-seven patients with early ARDS were randomly assigned to a group given decremental PEEP titration following ARM or a table-based PEEP (control) group. PEEP and inspired fraction of oxygen (FiO2) in the control group were set according to the table-based combinations of FiO2 and PEEP of the ARDS network, by which we aimed to achieve a PEEP level compatible with an oxygenation target. In the decremental PEEP titration group, the oxygen saturation and static compliance were monitored as the patients performed the ARM along with the extended sigh method, which is designed to gradually apply and withdraw a high distending pressure over a prolonged period, and the decremental titration of PEEP.
The baseline characteristics did not differ significantly between the control and decremental PEEP titration groups. Initial oxygenation improved more in the decremental PEEP titration group than in the control group. However, dynamic compliance, tidal volume and PEEP were similar in the two groups during the first week. The duration of use of paralysing or sedative agents, mechanical ventilation, stay in the intensive care unit and mortality at 28 days did not differ significantly between the decremental PEEP titration and control groups.
The daily decremental PEEP titration after ARM showed only initial oxygenation improvement compared with the table-based PEEP method. Respiratory mechanics and patient outcomes did not differ between the decremental PEEP titration and control groups.
ClinicalTrials.gov identifier: ISRCTN79027921.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>19239703</pmid><doi>10.1186/cc7725</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Springer Nature OA Free Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection; SpringerLink Journals - AutoHoldings |
| subjects | Acute respiratory distress syndrome Artificial respiration Care and treatment Diagnosis Female Health aspects Humans Male Middle Aged Patient outcomes Physiological aspects Positive-Pressure Respiration - methods Pulmonary Alveoli - physiology Respiratory Distress Syndrome, Adult - physiopathology Respiratory Distress Syndrome, Adult - therapy Respiratory Mechanics - physiology Respiratory physiology Titrimetry - methods |
| title | Efficacy of positive end-expiratory pressure titration after the alveolar recruitment manoeuvre in patients with acute respiratory distress syndrome |
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