Monitoring patients with ARDS, Part 1: How to measure respiratory mechanics. Strategies to enhance the benefits of mechanical ventilation and lessen complications

Alexander Duarte, A. Bidani

Research output: Contribution to journalArticle

Abstract

Large inspiratory tidal volume, rather than high peak airway pressure (Ppeak), may be responsible for ventilator-associated lung injury in patients with acute respiratory distress syndrome (ARDS). Sustained increases in Ppeak are, however, a nonspecific marker of airway complications and should be investigated. Plateau pressure (Pplat) is useful as an approximation of alveolar pressure; it should not exceed 35 cm H2O. Limiting Pplat by using smaller tidal volumes appears to mitigate the potential for lung injury and may reduce ARDS-related mortality. Intrinsic positive end-expiratory pressure (PEEP) can cause hemodynamic compromise; to detect it, an end-expiratory hold maneuver is performed. Applying external PEEP according to the location of the lower inflection point of the pressure-volume curve may improve oxygenation while helping to avoid barotrauma.

Original languageEnglish (US)
Pages (from-to)140-150
Number of pages11
JournalJournal of Critical Illness
Volume15
Issue number3
StatePublished - 2000

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Respiratory Mechanics
Adult Respiratory Distress Syndrome
Physiologic Monitoring
Artificial Respiration
Pressure
Positive-Pressure Respiration
Tidal Volume
Lung Injury
Barotrauma
Mechanical Ventilators
Hemodynamics
Mortality

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

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abstract = "Large inspiratory tidal volume, rather than high peak airway pressure (Ppeak), may be responsible for ventilator-associated lung injury in patients with acute respiratory distress syndrome (ARDS). Sustained increases in Ppeak are, however, a nonspecific marker of airway complications and should be investigated. Plateau pressure (Pplat) is useful as an approximation of alveolar pressure; it should not exceed 35 cm H2O. Limiting Pplat by using smaller tidal volumes appears to mitigate the potential for lung injury and may reduce ARDS-related mortality. Intrinsic positive end-expiratory pressure (PEEP) can cause hemodynamic compromise; to detect it, an end-expiratory hold maneuver is performed. Applying external PEEP according to the location of the lower inflection point of the pressure-volume curve may improve oxygenation while helping to avoid barotrauma.",
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