Effect of positive end-expiratory pressure on lung injury and haemodynamics during experimental acute respiratory distress syndrome treated with extracorporeal membrane oxygenation and near-apnoeic ventilation
Author
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Araos, Joaquín
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Alegría, Leyla
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García, Aline
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Cruces, Pablo
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Soto, Dagoberto
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Erranz, Benjamín
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Salomón, Tatiana
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Medina, Tania
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García, Patricio
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Dubo, Sebastián
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Bachmann, Maria C.
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Basoalto, Roque
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Valenzuela, Emilio D.
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Rovegno, Maximiliano
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Vera, Magdalena
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Retamal, Jaime
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Cornejo Rosas, Rodrigo Alfredo
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Bugedo, Guillermo
Author
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Bruhn, Alejandro
Admission date
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2022-03-03T22:12:31Z
Available date
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2022-03-03T22:12:31Z
Publication date
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2021
Cita de ítem
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British Journal of Anaesthesia, 127 (5): 807e814 (2021)
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Identifier
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10.1016/j.bja.2021.07.031
Identifier
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https://repositorio.uchile.cl/handle/2250/184044
Abstract
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Background: Lung rest has been recommended during extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS). Whether positive end-expiratory pressure (PEEP) confers lung protection during ECMO for severe ARDS is unclear. We compared the effects of three different PEEP levels whilst applying near-apnoeic ventilation in a model of severe ARDS treated with ECMO.
Methods: Acute respiratory distress syndrome was induced in anaesthetised adult male pigs by repeated saline lavage and injurious ventilation for 1.5 h. After ECMO was commenced, the pigs received standardised near-apnoeic ventilation for 24 h to maintain similar driving pressures and were randomly assigned to PEEP of 0, 10, or 20 cm H2O (n=7 per group). Respiratory and haemodynamic data were collected throughout the study. Histological injury was assessed by a pathologist masked to PEEP allocation. Lung oedema was estimated by wet-to-dry-weight ratio.
Results: All pigs developed severe ARDS. Oxygenation on ECMO improved with PEEP of 10 or 20 cm H2O, but did not in pigs allocated to PEEP of 0 cm H2O. Haemodynamic collapse refractory to norepinephrine (n=4) and early death (n=3) occurred after PEEP 20 cm H2O. The severity of lung injury was lowest after PEEP of 10 cm H2O in both dependent and non-dependent lung regions, compared with PEEP of 0 or 20 cm H2O. A higher wet-to-dry-weight ratio, indicating worse lung injury, was observed with PEEP of 0 cm H2O. Histological assessment suggested that lung injury was minimised with PEEP of 10 cm H2O.
Conclusions: During near-apnoeic ventilation and ECMO in experimental severe ARDS, 10 cm H2O PEEP minimised lung injury and improved gas exchange without compromising haemodynamic stability.
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Patrocinador
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Comision Nacional de Investigacion Cientifica y Tecnologica (Fondo Nacional de Desarrollo Cientifico y Tecnologico) 1130248
1161556
Comision Nacional de Investigacion Cientifica y Tecnologica/Doctorado Nacional/2013
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Lenguage
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en
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Publisher
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Elsevier
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Type of license
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Attribution-NonCommercial-NoDerivs 3.0 United States
Effect of positive end-expiratory pressure on lung injury and haemodynamics during experimental acute respiratory distress syndrome treated with extracorporeal membrane oxygenation and near-apnoeic ventilation