Setting the positive expiratory-end pressure-FIO2 in acute lung injury/acute respiratory distress syndrome.
Airspace collapse is a hallmark of parenchymal lung injury. Strategies to reopen and maintain patency of these regions offer three advantages: improved gas exchange, less ventilator-induced lung injury, and improved lung compliance. Elevations in intrathoracic pressure to achieve these goals, however, may overdistend healthier lung regions and compromise cardiac function. Positive end-expiratory pressure is a widely used technique to maintain alveolar patency, but its beneficial effects must be balanced against its harmful effects. Mechanical approaches to achieve this balance are clinically difficult to do. Thus gas exchange algorithms with modest PaO2 goals are commonly used today. Recruitment maneuvers and long inspiratory time strategies may be useful adjuncts.
Department of Pulmonary and Critical Care, Duke University Medical Center, Box 3911, Erwin Road, Durham, NC 27710, USA. macin001@mc.duke.edu
Neil R
NR
MacIntyre
D000465:Algorithms; D000818:Animals; D006801:Humans; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy*; D015656:Respiratory Mechanics / Q000502:physiology