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Monitoring dead space during recruitment and PEEP titration in an experimental model

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Abstract

Objective

To test the usefulness of dead space for determining open-lung PEEP, the lowest PEEP that prevents lung collapse after a lung recruitment maneuver.

Design

Prospective animal study.

Setting

Department of Clinical Physiology, University of Uppsala, Sweden.

Subjects

Eight lung-lavaged pigs.

Interventions

Animals were ventilated using constant flow mode with VT of 6 ml/kg, respiratory rate of 30 bpm, inspiratory-to-expiratory ratio of 1 : 2, and FiO2 of 1. Baseline measurements were performed at 6 cmH2O of PEEP. PEEP was increased in steps of 6 cmH2O from 6 to 24 cmH2O. Recruitment maneuver was achieved within 2 min at pressure levels of 60/30 cmH2O for Peak/PEEP. PEEP was decreased from 24 to 6 cmH2O in steps of 2 cmH2O and then to 0 cmH2O. Each PEEP step was maintained for 10 min.

Measurements and results

Alveolar dead space (VDalv), the ratio of alveolar dead space to alveolar tidal volume (VDalv/VTalv), and the arterial to end-tidal PCO2 difference (Pa-etCO2) showed a good correlation with PaO2, normally aerated areas, and non-aerated CT areas in all animals (minimum–maximum r2 = 0.83–0.99; p < 0.01). Lung collapse (non-aerated tissue > 5%) started at 12 cmH2O PEEP; hence, open-lung PEEP was established at 14 cmH2O. The receiver operating characteristics curve demonstrated a high specificity and sensitivity of VDalv (0.89 and 0.90), VDalv/VTalv (0.82 and 1.00), and Pa − etCO2 (0.93 and 0.95) for detecting lung collapse.

Conclusions

Monitoring of dead space was useful for detecting lung collapse and for establishing open-lung PEEP after a recruitment maneuver.

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Acknowledgements

We thank A. Roneus, E.-M. Hedin, K. Fagerbrink (laboratory assistants at the Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala Sweden), and O. Thamm (medical student at Department of Anesthesiology, University Hospital, Hamburg-Eppendorf, Hamburg, Germany) for their invaluable assistance, and I. Passoni (Department of Bioengineering, University of Mar del Plata, Argentina) for her expert help with data analysis. This work was performed in the Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala Sweden. Support was provided by the Swedish Medical Research Council (5315), the Swedish Heart-Lung Fund and Maquet Critical Care.

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Authors and Affiliations

  1. Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina

    Gerardo Tusman

  2. Department of Critical Care Medicine, Fundación Jiménez Díaz-UTE, Madrid, Spain

    Fernando Suarez-Sipmann

  3. Department of Anesthesiology, University Hospital, Hamburg-Eppendorf, Hamburg, Germany

    Stephan H. Böhm & Hajo Reissmann

  4. Clinic of Anesthesiology and Per-operative Intensive Care, University of Veterinary Medicine, Vienna, Austria

    Tanja Pech

  5. Department of Bioengineering, University of Mar del Plata, Mar del Plata, Argentina

    Gustavo Meschino & Adriana Scandurra

  6. Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala, Sweden

    Göran Hedenstierna

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  1. Gerardo Tusman
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Corresponding author

Correspondence to Gerardo Tusman.

Additional information

This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-006-0372-6

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Tusman, G., Suarez-Sipmann, F., Böhm, S.H. et al. Monitoring dead space during recruitment and PEEP titration in an experimental model. Intensive Care Med 32, 1863–1871 (2006). https://doi.org/10.1007/s00134-006-0371-7

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