Please use this identifier to cite or link to this item:
Full metadata record
DC FieldValueLanguage
dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP-
dc.contributor.authorMATOS, Gustavo F. J. de-
dc.contributor.authorSTANZANI, Fabiana-
dc.contributor.authorPASSOS, Rogerio H.-
dc.contributor.authorFONTANA, Mauricio F.-
dc.contributor.authorALBALADEJO, Renata-
dc.contributor.authorCASERTA, Raquel E.-
dc.contributor.authorSANTOS, Durval C. B.-
dc.contributor.authorBORGES, Joao Batista-
dc.contributor.authorAMATO, Marcelo B. P.-
dc.contributor.authorBARBAS, Carmen S. V.-
dc.identifier.citationCRITICAL CARE, v.16, n.1, article ID R4, 14p, 2012-
dc.description.abstractIntroduction: The benefits of higher positive end expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS) have been modest, but few studies have fully tested the ""open-lung hypothesis"". This hypothesis states that most of the collapsed lung tissue observed in ARDS can be reversed at an acceptable clinical cost, potentially resulting in better lung protection, but requiring more intensive maneuvers. The short-/middle-term efficacy of a maximum recruitment strategy (MRS) was recently described in a small physiological study. The present study extends those results, describing a case-series of non-selected patients with early, severe ARDS submitted to MRS and followed until hospital discharge or death. Methods: MRS guided by thoracic computed tomography (CT) included two parts: a recruitment phase to calculate opening pressures (incremental steps under pressure-controlled ventilation up to maximum inspiratory pressures of 60 cmH(2)O, at constant driving-pressures of 15 cmH(2)O); and a PEEP titration phase (decremental PEEP steps from 25 to 10 cmH2O) used to estimate the minimum PEEP to keep lungs open. During all steps, we calculated the size of the non-aerated (-100 to +100 HU) compartment and the recruitability of the lungs (the percent mass of collapsed tissue re-aerated from baseline to maximum PEEP). Results: A total of 51 severe ARDS patients, with a mean age of 50.7 years (84% primary ARDS) was studied. The opening plateau-pressure was 59.6 (+/- 5.9 cmH(2)O), and the mean PEEP titrated after MRS was 24.6 (+/- 2.9 cmH(2)O). Mean PaO2/FiO(2) ratio increased from 125 (+/- 43) to 300 (+/- 103; P < 0.0001) after MRS and was sustained above 300 throughout seven days. Non-aerated parenchyma decreased significantly from 53.6% (interquartile range (IQR): 42.5 to 62.4) to 12.7% (IQR: 4.9 to 24.2) (P < 0.0001) after MRS. The potentially recruitable lung was estimated at 45% (IQR: 25 to 53). We did not observe major barotrauma or significant clinical complications associated with the maneuver. Conclusions: MRS could efficiently reverse hypoxemia and most of the collapsed lung tissue during the course of ARDS, compatible with a high lung recruitability in non-selected patients with early, severe ARDS. This strategy should be tested in a prospective randomized clinical trial.-
dc.relation.ispartofCritical Care-
dc.subject.otherend-expiratory pressure-
dc.subject.otherrandomized controlled-trial-
dc.subject.otherarterial pulse pressure-
dc.subject.othermechanical ventilation-
dc.subject.othertidal volume-
dc.subject.otherrecruitment maneuvers-
dc.subject.otherprotective ventilation-
dc.subject.otherfluid responsiveness-
dc.titleHow large is the lung recruitability in early acute respiratory distress syndrome: a prospective case series of patients monitored by computed tomography-
dc.rights.holderCopyright BIOMED CENTRAL LTD-
dc.subject.wosCritical Care Medicine-
dc.type.categoryoriginal article-
dc.type.versionpublishedVersion-, Gustavo F. J. de:Adult ICU Hosp Israelita Albert Einstein, BR-05652000 Sao Paulo, Brazil-, Fabiana:Adult ICU Hosp Israelita Albert Einstein, BR-05652000 Sao Paulo, Brazil-, Rogerio H.:Adult ICU Hosp Israelita Albert Einstein, BR-05652000 Sao Paulo, Brazil-, Mauricio F.:Adult ICU Hosp Israelita Albert Einstein, BR-05652000 Sao Paulo, Brazil-, Renata:Adult ICU Hosp Israelita Albert Einstein, BR-05652000 Sao Paulo, Brazil-, Raquel E.:Adult ICU Hosp Israelita Albert Einstein, BR-05652000 Sao Paulo, Brazil-, Durval C. B.:Hosp Israelita Albert Einstein, Dept Radiol, BR-05652000 Sao Paulo, Brazil-
hcfmusp.relation.referenceAmato MBP, 1997, ACUTE LUNG INJURY, V30, P258-
hcfmusp.relation.referenceAmato MBP, 1996, AM J RESP CRIT CARE, V153, pA375-
hcfmusp.relation.referenceAmato MBP, 1998, NEW ENGL J MED, V339, P196-
hcfmusp.relation.referenceBarbas CSV, 2005, CURR OPIN CRIT CARE, V11, P18, DOI 10.1097/00075198-200502000-00004-
hcfmusp.relation.referenceBlanch Lluis, 2002, Respir Care Clin N Am, V8, P281, DOI 10.1016/S1078-5337(02)00009-6-
hcfmusp.relation.referenceBlank R, 2011, CRIT CARE CLIN, V27, P439, DOI 10.1016/j.ccc.2011.05.005-
hcfmusp.relation.referenceBohm SH, 1998, YB INTENSIVE CARE EM, P430-
hcfmusp.relation.referenceBorges JB, 2006, NEW ENGL J MED, V355, P319-
hcfmusp.relation.referenceBorges JB, 2006, AM J RESP CRIT CARE, V174, P268, DOI 10.1164/rccm.200506-97OC-
hcfmusp.relation.referenceBriel M, 2010, JAMA-J AM MED ASSOC, V303, P865, DOI 10.1001/jama.2010.218-
hcfmusp.relation.referenceBrower RG, 2004, NEW ENGL J MED, V351, P327-
hcfmusp.relation.referenceCaironi P, 2010, AM J RESP CRIT CARE, V181, P578, DOI 10.1164/rccm.200905-0787OC-
hcfmusp.relation.referenceChiumello D, 2008, AM J RESP CRIT CARE, V178, P346, DOI 10.1164/rccm.200710-1589OC-
hcfmusp.relation.referenceDAngelo E, 1997, EUR RESPIR J, V10, P2343, DOI 10.1183/09031936.97.10102343-
hcfmusp.relation.referenceDe Backer D, 2005, INTENS CARE MED, V31, P517, DOI 10.1007/s00134-005-2586-4-
hcfmusp.relation.referenceDREYFUSS D, 1993, AM REV RESPIR DIS, V148, P1194-
hcfmusp.relation.referenceDreyfuss D, 1998, AM J RESP CRIT CARE, V157, P294-
hcfmusp.relation.referenceDreyfuss D, 1994, PRINCIPLES PRACTICE, P793-
hcfmusp.relation.referenceEGAN EA, 1982, J APPL PHYSIOL, V53, P121-
hcfmusp.relation.referenceEstenssoro E, 2002, CRIT CARE MED, V30, P2450, DOI 10.1037/01.CCM.0000034692.46267.02-
hcfmusp.relation.referenceFrank JA, 2003, ACUTE RESP DISTRESS, V179, P201-
hcfmusp.relation.referenceFujino Y, 2001, CRIT CARE MED, V29, P1579, DOI 10.1097/00003246-200108000-00014-
hcfmusp.relation.referenceGattinoni L, 2006, NEW ENGL J MED, V354, P1775, DOI 10.1056/NEJMoa052052-
hcfmusp.relation.referenceGattinoni L, 2005, CURR OPIN CRIT CARE, V11, P69, DOI 10.1097/00075198-200502000-00011-
hcfmusp.relation.referenceGattinoni L, 2003, CRIT CARE MED, V31, pS300, DOI 10.1097/01.CCM.0000057907.46502.7B-
hcfmusp.relation.referenceGattinoni L, 2001, AM J RESP CRIT CARE, V164, P1701-
hcfmusp.relation.referenceGirgis K, 2006, RESPIR CARE, V51, P1132-
hcfmusp.relation.referenceLACHMANN B, 1992, INTENS CARE MED, V18, P319, DOI 10.1007/BF01694358-
hcfmusp.relation.referenceMarini JJ, 2004, CRIT CARE MED, V32, P250, DOI 10.1097/01.CCM.0000104946.66723.A8-
hcfmusp.relation.referenceMatos GFJ, 2010, CRITICAL CARE S1, V14, pP186-
hcfmusp.relation.referenceMeade MO, 2008, JAMA-J AM MED ASSOC, V299, P637, DOI 10.1001/jama.299.6.637-
hcfmusp.relation.referenceMercat A, 2008, JAMA-J AM MED ASSOC, V299, P646, DOI 10.1001/jama.299.6.646-
hcfmusp.relation.referenceMichard F, 1999, AM J RESP CRIT CARE, V159, P935-
hcfmusp.relation.referenceMichard F, 2000, AM J RESP CRIT CARE, V162, P134-
hcfmusp.relation.referenceMUSCEDERE JG, 1994, AM J RESP CRIT CARE, V149, P1327-
hcfmusp.relation.referencePapadakos PJ, 2007, CRIT CARE CLIN, V23, P241, DOI 10.1016/j.ccc.2006.12.001-
hcfmusp.relation.referencePARKER JC, 1993, CRIT CARE MED, V21, P131, DOI 10.1097/00003246-199301000-00024-
hcfmusp.relation.referenceRanieri VM, 1999, JAMA-J AM MED ASSOC, V282, P54, DOI 10.1001/jama.282.1.54-
hcfmusp.relation.referenceRichards GA, 2002, CRIT CARE MED, V30, P2169, DOI 10.1097/01.CCM.0000026739.95729.50-
hcfmusp.relation.referenceSantos Claudia C dos, 2005, Crit Care, V9, P280-
hcfmusp.relation.referenceSchreiter D, 2004, CRIT CARE MED, V32, P968, DOI 10.1097/01.CCM.0000120050.85798.38-
hcfmusp.relation.referenceSuh GY, 2002, CRIT CARE MED, V30, P1848, DOI 10.1097/01.CCM.0000021177.83239.1A-
hcfmusp.relation.referenceTalmor D, 2008, NEW ENGL J MED, V359, P2095, DOI 10.1056/NEJMoa0708638-
hcfmusp.relation.referenceTerragni PP, 2007, AM J RESP CRIT CARE, V175, P160, DOI 10.1164/rccm.200607-915OC-
hcfmusp.relation.referenceBrower RG, 2000, NEW ENGL J MED, V342, P1301-
hcfmusp.relation.referenceTremblay L, 1997, J CLIN INVEST, V99, P944, DOI 10.1172/JCI119259-
hcfmusp.relation.referenceVieillard-Baron A, 2002, CRIT CARE MED, V30, P726-
hcfmusp.relation.referenceVieillard-Baron A, 2001, CRIT CARE MED, V29, P1551, DOI 10.1097/00003246-200108000-00009-
hcfmusp.relation.referenceVillagra A, 2002, AM J RESP CRIT CARE, V165, P165-
hcfmusp.relation.referenceVillar J, 2006, CRIT CARE MED, V34, P1311, DOI 10.1097/01.CCM.0000215598.84885.01-
hcfmusp.relation.referenceVillar J, 2011, INTENS CARE MED, V37, P1932, DOI 10.1007/s00134-011-2380-4-
hcfmusp.relation.referenceWEBB HH, 1974, AM REV RESPIR DIS, V110, P556-
Appears in Collections:

Artigos e Materiais de Revistas Científicas - HC/ICHC
Instituto Central - HC/ICHC

Artigos e Materiais de Revistas Científicas - HC/InCor
Instituto do Coração - HC/InCor

Artigos e Materiais de Revistas Científicas - LIM/09
LIM/09 - Laboratório de Pneumologia

Files in This Item:
File Description SizeFormat 
  Restricted Access
publishedVersion (English)1.07 MBAdobe PDFView/Open Request a copy

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.