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Prospective observational study to evaluate the effect of different levels of positive end-expiratory pressure on lung mechanics in patients with and without acute respiratory distress syndrome

Background: The optimal level of positive end-expiratory pressure is still under debate. There are scare data examining the association of PEEP with transpulmonary pressure (TPP), end-expiratory lung volume (EELV) and intraabdominal pressure in ventilated patients with and without ARDS. Methods: We...

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Main Authors: Fiedler-Kalenka, Mascha (Author) , Diktanaite, Dovile (Author) , Simeliunas, Emilis (Author) , Pilz, Maximilian (Author) , Kalenka, Armin (Author)
Format: Article (Journal)
Language:English
Published: 31 July 2020
In: Journal of Clinical Medicine
Year: 2020, Volume: 9, Issue: 8
ISSN:2077-0383
DOI:10.3390/jcm9082446
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.3390/jcm9082446
Verlag, lizenzpflichtig, Volltext: https://www.mdpi.com/2077-0383/9/8/2446
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Author Notes:Mascha O. Fiedler, Dovile Diktanaite, Emilis Simeliunas, Maximilian Pilz and Armin Kalenka
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Summary:Background: The optimal level of positive end-expiratory pressure is still under debate. There are scare data examining the association of PEEP with transpulmonary pressure (TPP), end-expiratory lung volume (EELV) and intraabdominal pressure in ventilated patients with and without ARDS. Methods: We analyzed lung mechanics in 3 patient groups: group A, patients with ARDS; group B, obese patients (body mass index (BMI) > 30 kg/m2) and group C, a control group. Three levels of PEEP (5, 10, 15 cm H2O) were used to investigate the consequences for lung mechanics. Results: Fifty patients were included, 22 in group A, 18 in group B (BMI 38 ± 2 kg/m2) and 10 in group C. At baseline, oxygenation showed no differences between the groups. Driving pressure (ΔP) and transpulmonary pressure (ΔPL) was higher in group B than in groups A and C at a PEEP of 5 cm H2O (ΔP A: 15 ± 1, B: 18 ± 1, C: 14 ± 1 cm H2O; ΔPL A: 10 ± 1, B: 13 ± 1, C: 9 ± 0 cm H2O). Peak inspiratory pressure (Pinsp) rose in all groups as PEEP increased, but the resulting driving pressure and transpulmonary pressure were reduced, whereas EELV increased. Conclusion: Measuring EELV or TPP allows a personalized approach to lung-protective ventilation.
Item Description:Gesehen am 05.10.2020
Physical Description:Online Resource
ISSN:2077-0383
DOI:10.3390/jcm9082446

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