title: Effects of sustained inflation and postinflation positive end-expiratory pressure in acute respiratory distress syndrome: focusing on pulmonary and extrapulmonary forms.
abstract: OBJECTIVE
  To investigate whether the response to sustained inflation and postinflation positive end-expiratory pressure varies between acute respiratory distress syndrome with pulmonary (ARDS(exp)) and extrapulmonary origin (ARDS(exp)).
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  Multidisciplinary intensive care unit in a university hospital.
  
  
  METHODS
  A total of 11 patients with ARDS and 13 patients with ARDS.
  
  
  METHODS
  A 7 ml/kg tidal volume, 12-15 breaths/min respiratory rate, and an inspiratory/expiratory ratio of 1:2 was used during baseline ventilation. Positive end-expiratory pressure levels were set according to the decision of the primary physician. Sustained inflation was performed by 45 cm H2O continuous positive airway pressure for 30 secs. Postinflation positive end-expiratory pressure was titrated decrementally, starting from a level of 20 cm H2O to keep the peripheral oxygen saturation between 92% and 95%. Fio2 was decreased, and baseline tidal volume, respiratory rate, inspiratory/expiratory ratio were maintained unchanged throughout the study period.
  
  
  RESULTS
  Blood gas, airway pressure, and hemodynamic measurements were performed at the following time points: at baseline and at 15 mins, 1 hr, 4 hrs, and 6 hrs after sustained inflation. After sustained inflation, the Pao2/Fio2 ratio improved in all of the patients both in ARDS(p) and ARDS(exp). However, the Pao2/Fio2 ratio increased to >200 in four ARDS(p) patients (36%) and in seven ARDS(p) patients (54%). In two of those ARDS patients, the Pao2/Fio2 ratio was found to be <200, whereas none of the ARDS(p) patients revealed Pao2/Fio2 ratios of <200 at the 6-hr measurement. Postinflation positive end-expiratory pressure levels were set at 16.7 +/- 2.3 cm H O in ARDS(p) and 15.6 +/- 2.5 cm H2O in ARDS. The change in Pao /Fio ratios was found statistically significant in patients with ARDS(p) (p =.0001) and with ARDS(p) (p =.008). Respiratory system compliance increased in ARDS patients (p =.02), whereas the change in ARDS was not statistically significant.
  
  
  CONCLUSIONS
  Sustained inflation followed by high levels of postinflation positive end-expiratory pressure provided an increase in respiratory system compliance in ARDS; however, arterial oxygenation improved in both ARDS forms.
authors.affiliation: Anesthesiology Department, Istanbul Medical Faculty, Turkey.
authors.forename: Simru
authors.initials: S
authors.lastname: Tugrul
authors.forename: Ozkan
authors.initials: O
authors.lastname: Akinci
authors.forename: Perihan E
authors.initials: PE
authors.lastname: Ozcan
authors.forename: Sibel
authors.initials: S
authors.lastname: Ince
authors.forename: Figen
authors.initials: F
authors.lastname: Esen
authors.forename: Lutfi
authors.initials: L
authors.lastname: Telci
authors.forename: Kutay
authors.initials: K
authors.lastname: Akpir
authors.forename: Nahit
authors.initials: N
authors.lastname: Cakar
mesh_terms: D000328:Adult; D000368:Aged; D000403:Airway Resistance; D000704:Analysis of Variance; D001784:Blood Gas Analysis; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008170:Lung Compliance; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D015656:Respiratory Mechanics; D018805:Sepsis / Q000150:complications; D013898:Thoracic Injuries / Q000150:complications; D013990:Tidal Volume; D013997:Time Factors; D016896:Treatment Outcome