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Crit Care Med. 2012 Jul;40(7):2176-81. doi: 10.1097/CCM.0b013e318250aa40.

Experimental intra-abdominal hypertension attenuates the benefit of positive end-expiratory pressure in ventilating effusion-compressed lungs*.

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1
Regions Hosptial, St Paul, MN, USA.

Abstract

OBJECTIVE:

To test the ability of positive end-expiratory pressure to offset the reduction of resting lung volume caused by intra abdominal hypertension, unilateral pleural effusion, and their combination.

DESIGN:

: Controlled application of intrapleural fluid, raised abdominal pressure and their combination before and after positive end-expiratory pressure in an anesthetized porcine model of controlled ventilation.

SETTING:

Large animal laboratory of a university-affiliated hospital.

SUBJECTS:

Fourteen deeply anesthetized swine (weight 30-35 kg).

INTERVENTIONS:

Unilateral pleural effusion instillation (13 mL/kg), intra-abdominal hypertension (15 mm Hg), and simultaneous pleural effusion/intra abdominal hypertension.

MEASUREMENTS:

Tidal compliance, end-expiratory lung aeration by gas dilution functional residual capacity, and quantitative analyses of computerized tomograms of the lungs at the extremes of the tidal cycle.

MAIN RESULTS:

Positive end-expiratory pressure of 10 cm H2O (positive end-expiratory pressure 10) increased mean functional residual capacity by 368 mL when pleural effusion was present and by 184 mL when intra-abdominal hypertension was present. When pleural effusion and intra-abdominal hypertension were simultaneously applied, positive end-expiratory pressure 10 failed to improve tidal compliance and increased functional residual capacity by only 77 mL, whereastidal recruitment during ventilation remained substantial.

CONCLUSIONS:

The presence of intra-abdominal hypertension negates most of the positive end-expiratory pressure 10 benefit in reversing pleural effusion-induced de-recruitment. Relief of intra-abdominal hypertension may be instrumental to the treatment of pleural effusion-associated lung restriction and cyclical tidal collapse and reopening.

PMID:
22710205
DOI:
10.1097/CCM.0b013e318250aa40
[Indexed for MEDLINE]
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