In:
Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 6 ( 2019-06), p. 792-799
Kurzfassung:
Acute respiratory distress syndrome is a clinical syndrome characterized by a refractory hypoxemia due to an inflammatory and high permeability pulmonary edema secondary to direct or indirect lung insult (pulmonary and extrapulmonary form). Aim of this study was to evaluate in a large database of acute respiratory distress syndrome patients, the pulmonary versus extrapulmonary form in terms of respiratory mechanics, lung recruitment, gas exchange, and positive end-expiratory pressure response. Design: A secondary analysis of previously published data. Patients: One-hundred eighty-one sedated and paralyzed acute respiratory distress syndrome patients (age 60 yr [46–72 yr], body mass index 25 kg/m 2 [22–28 kg/m 2 ], and Pa o 2 /F io 2 184 ± 66). Interventions: Lung CT scan performed at 5 and 45 cm H 2 O. Two levels of positive end-expiratory pressure (5 and 15 cm H 2 O) were randomly applied. Measurements and Main Results: Ninety-seven and 84 patients had a pulmonary and extrapulmonary acute respiratory distress syndrome. The median time from intensive care admission to the CT scan and respiratory mechanics analysis was 4 days (interquartile range, 2–6). At both positive end-expiratory pressure levels, pulmonary acute respiratory distress syndrome presented a significantly lower Pa o 2 /F io 2 and higher physiologic dead space compared with extrapulmonary acute respiratory distress syndrome. The lung and chest wall elastance were similar between groups. The intra-abdominal pressure was significantly higher in extrapulmonary compared with pulmonary acute respiratory distress syndrome (10 mm Hg [7–12 mm Hg] vs 7 mm Hg [5–8 mm Hg] ). The lung weight and lung recruitability were significantly higher in pulmonary acute respiratory distress syndrome (1,534 g [1,286–1,835 g ] vs 1,342 g [1,090–1,507 g ] and 16% [9–25%] vs 9% [5–14%]). Conclusions: In the early stage, pulmonary acute respiratory distress syndrome is characterized by a greater impairment of gas exchange and higher lung recruitability. The recognition of the origin of acute respiratory distress syndrome is important for a more customized ventilatory management.
Materialart:
Online-Ressource
ISSN:
0090-3493
DOI:
10.1097/CCM.0000000000003715
Sprache:
Englisch
Verlag:
Ovid Technologies (Wolters Kluwer Health)
Publikationsdatum:
2019
ZDB Id:
2034247-0
