Journal ArticleDOI
High Inflation Pressure Pulmonary Edema: Respective Effects of High Airway Pressure, High Tidal Volume, and Positive End-expiratory Pressure
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To the authors' knowledge, this constitutes the first example of a protective effect of PEEP during permeability edema, which was markedly reduced by PEEP and preserved the normal ultrastructural aspect of the alveolar epithelium.Abstract:
The respective roles of high pressure and high tidal volume to promote high airway pressure pulmonary edema are unclear. Positive end-expiratory pressure (PEEP) was shown to reduce lung water content in this type of edema, but its possible effects on cellular lesions were not documented. We compared the consequences of normal tidal volume ventilation in mechanically ventilated rats at a high airway pressure (HiP-LoV) with those of high tidal volume ventilation at a high (HiP-HiV) or low (LoP-HiV) airway pressure and the effects of PEEP (10 cm H2O) on both edema and lung ultrastructure. Pulmonary edema was assessed by extravascular lung water content and microvascular permeability by the dry lung weight and the distribution space of 125I-labeled albumin. HiP-LoV rat lungs were not different from those of controls (7 cm H2O peak pressure ventilation). By contrast, the lungs from the groups submitted to high volume ventilation had significant permeability type edema. This edema was more pronounced in LoP-HiV...read more
Citations
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The acute respiratory distress syndrome
TL;DR: An overview of the definitions, clinical features, and epidemiology of the acute respiratory distress syndrome is provided and advances in the areas of pathogenesis, resolution, and treatment are discussed.
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Ventilator-induced lung injury: lessons from experimental studies.
Didier Dreyfuss,Georges Saumon +1 more
TL;DR: This paper presents experimental evidence for Increased Vascular Transmural Pressure Evidence for Alterations in Alveolar–Capillary Permeability Contributions of the Static and Dynamic Lung Volume Components to Ventilator-induced Edema High-volume Lung Edema Low Lung Volume Injury.
Journal ArticleDOI
Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress Syndrome
Roy G. Brower,Paul N. Lanken,Neil R. MacIntyre,Michael A. Matthay,Alan H. Morris,Marek Ancukiewicz,David A. Schoenfeld,B. Taylor Thompson +7 more
TL;DR: In patients with acute lung injury and ARDS who receive mechanical ventilation with a tidal-volume goal of 6 ml per kilogram of predicted body weight and an end-inspiratory plateau-pressure limit of 30 cm of water, clinical outcomes are similar whether lower or higher PEEP levels are used.
Journal ArticleDOI
Driving Pressure and Survival in the Acute Respiratory Distress Syndrome
Marcelo B. P. Amato,Maureen O. Meade,Arthur S. Slutsky,Laurent J. Brochard,Eduardo L. V. Costa,David A. Schoenfeld,Thomas E. Stewart,Matthias Briel,Matthias Briel,Daniel Talmor,Alain Mercat,Jean-Christophe Richard,Carlos Roberto Ribeiro de Carvalho,Roy G. Brower +13 more
TL;DR: It is found that ΔP was the ventilation variable that best stratified risk and decreases in ΔP owing to changes in ventilator settings were strongly associated with increased survival.
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The acute respiratory distress syndrome.
TL;DR: Progress has been made in understanding the mechanisms responsible for the pathogenesis and the resolution of lung injury, including the contribution of environmental and genetic factors, and on developing novel therapeutics that can facilitate and enhance lung repair.
References
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Journal ArticleDOI
Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures. Protection by positive end-expiratory pressure.
TL;DR: It is postulate that interstitial perivascular edema develops from ventilation with high inflating pressures by mechanisms of lung interdependen...
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Intermittent positive-pressure hyperventilation with high inflation pressures produces pulmonary microvascular injury in rats.
TL;DR: HIPPV edema presents all the features of high permeability edema and may be of concern in the ventilatory management of patients with acute respiratory failure in order to avoid additional damages induced by local overinflation.
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Structural alterations of lung parenchyma in the adult respiratory distress syndrome.
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Measurement of Pulmonary Edema
TL;DR: The isotope transit time method is concluded that the edema water is determined more accurately when pulmonary edema is due to elevated pulmonary venous pressure than when due to increased vascular permeability.
Journal ArticleDOI
Ventilation with end-expiratory pressure in acute lung disease
TL;DR: The most probable explanation for the effect of PEEP on P(aO2) and compliance is recruitment of gas exchange airspaces and prevention of terminal airway closure.