Individualized Positive End-expiratory Pressure and Regional Gas Exchange in Porcine Lung Injury

Conclusions When compared to table PEEP without a recruitment maneuver, both minimal tidal recruitment PEEP and maximal oxygenation PEEP following a recruitment maneuver decreased shunting and dead space ventilation, and the effects of minimal tidal recruitment PEEP and maximal oxygenation PEEP were comparable.Editor ’s PerspectiveWhat We Already Know about This TopicIn acute lung injury, the optimal positive end-expiratory pressure (PEEP) strategy for mechanical ventilation is not known.What This Article Tells Us That Is NewIn a porcine model of induced acute lung injury, with increased abdominal pressure caused by intraperitoneal saline infusion, using a crossover design, tracheostomized animals were ventilated using: (1) positive end-expiratory pressure (PEEP) table –based low PEEP without lung recruitment; (2) minimal tidal recruitment PEEP guided by electrical impedance tomography with recruitment; and (3) maximal oxygenation PEEP with recruitment.Using a PEEP table and no recruitment, compared with recruitment and either minimal tidal recruitment PEEP or maximal oxygenation PEEP, resulted in less delivered PEEP, and more lung collapse and regional ventilation/perfusion mismatch. The latter two methods had comparable results.

Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research