title: [Effects of the positive end-expiratory pressure increase on sublingual microcirculation in patients with acute respiratory distress syndrome].
abstract: OBJECTIVE
  The aim of this study was to evaluate the impact of increased positive end-expiratory pressure on the sublingual microcirculation.
  
  
  METHODS
  Adult patients who were sedated, under mechanical ventilation, and had a diagnosis of circulatory shock and acute respiratory distress syndrome were included. The positive end-expiratory pressure level was settled to obtain a plateau pressure of 30cmH2O and then maintained at this level for 20minutes. Microcirculatory (obtained by videomicroscopy) and hemodynamic variables were collected at baseline and compared with those at the end of 20min.
  
  
  RESULTS
  Twelve patients were enrolled. Overall, the microcirculation parameters did not significantly change after increasing the positive end-expiratory pressure. However, there was considerable interindividual variability. There was a negative, moderate correlation between the changes in the De Backer score (r=-0.58, p=0.048), total vessel density (r=-0.60, p=0.039) and baseline values. The changes in total vessel density (r=0.54, p=0.07) and perfused vessel density (r=0.52, p=0.08) trended toward correlating with the changes in the mean arterial pressure.
  
  
  CONCLUSIONS
  Overall, the microcirculation parameters did not significantly change after increasing the positive end-expiratory pressure. However, at individual level, such response was heterogeneous. The changes in the microcirculation parameters could be correlated with the baseline values and changes in the mean arterial pressure.
authors.affiliation: Universidade Federal de São Paulo (Unifesp), Hospital de São Paulo, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brasil.
authors.forename: Nathaly Fonseca
authors.initials: NF
authors.lastname: Nunes
authors.affiliation: Universidade Federal de São Paulo (Unifesp), Hospital de São Paulo, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brasil. Electronic address: tonybafi@gmail.com.
authors.forename: Antônio Tonete
authors.initials: AT
authors.lastname: Bafi
authors.affiliation: Universidade Federal de São Paulo (Unifesp), Hospital de São Paulo, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brasil.
authors.forename: Eduardo Souza
authors.initials: ES
authors.lastname: Pacheco
authors.affiliation: Universidade Federal de São Paulo (Unifesp), Hospital de São Paulo, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brasil.
authors.forename: Luciano Cesar Pontes de
authors.initials: LCP
authors.lastname: Azevedo
authors.affiliation: Universidade Federal de São Paulo (Unifesp), Hospital de São Paulo, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brasil.
authors.forename: Flavia Ribeiro
authors.initials: FR
authors.lastname: Machado
authors.affiliation: Universidade Federal de São Paulo (Unifesp), Hospital de São Paulo, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brasil.
authors.forename: Flávio Geraldo Rezende
authors.initials: FGR
authors.lastname: Freitas
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply*; D011175:Positive-Pressure Respiration; D012128:Respiratory Distress Syndrome / Q000503:physiopathology* / Q000628:therapy*
keywords: Adult respiratory distress syndrome; Choque; Hemodinâmica; Hemodynamics; Mechanical ventilators; Microcirculation; Microcirculação; Positive end‐expiratory pressure; Pressão positiva expiratória final; Shock; Síndrome do desconforto respiratório do adulto; Ventiladores mecânicos