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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP-
dc.contributor.authorYOSHIDA, Takeshi-
dc.contributor.authorTORSANI, Vinicius-
dc.contributor.authorGOMES, Susimeire-
dc.contributor.authorSANTIS, Roberta R. De-
dc.contributor.authorBERALDO, Marcelo A.-
dc.contributor.authorCOSTA, Eduardo L. V.-
dc.contributor.authorTUCCI, Mauro R.-
dc.contributor.authorZIN, Walter A.-
dc.contributor.authorKAVANAGH, Brian P.-
dc.contributor.authorAMATO, Marcelo B. P.-
dc.identifier.citationAMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, v.188, n.12, p.1420-1427, 2013-
dc.description.abstractRationale: In normal lungs, local changes in pleural pressure (P-pl) are generalized over the whole pleural surface. However, in a patient with injured lungs, we observed (using electrical impedance tomography) a pendelluft phenomenon (movement of air within the lung from nondependent to dependent regions without change in tidal volume) that was caused by spontaneous breathing during mechanical ventilation. Objectives: To test the hypotheses that in injured lungs negative P-pl generated by diaphragm contraction has localized effects (in dependent regions) that are not uniformly transmitted, and that such localized changes in P-pl cause pendelluft. Methods: We used electrical impedance tomography and dynamic computed tomography (CT) to analyze regional inflation in anesthetized pigs with lung injury. Changes in local P-pl were measured in nondependent versus dependent regions using intrabronchial balloon catheters. The airway pressure needed to achieve comparable dependent lung inflation during paralysis versus spontaneous breathing was estimated. Measurements and Main Results: In all animals, spontaneous breathing caused pendelluft during early inflation, which was associated with more negative local P-pl in dependent regions versus nondependent regions (-13.0 +/- 4.0 vs. -6.4 +/- 3.8 cm H2O; P < 0.05). Dynamic CT confirmed pendelluft, which occurred despite limitation of tidal volume to less than 6 ml/kg. Comparable inflation of dependent lung during paralysis required almost threefold greater driving pressure (and tidal volume) versus spontaneous breathing (28.0 +/- 0.5 vs. 10.3 +/- 0.6 cm H2O, P < 0.01; 14.8 +/- 4.6 vs. 5.8 +/- 1.6 ml/kg, P < 0.05). Conclusions: Spontaneous breathing effort during mechanical ventilation causes unsuspected overstretch of dependent lung during early inflation (associated with reciprocal deflation of nondependent lung). Even when not increasing tidal volume, strong spontaneous effort may potentially enhance lung damage.-
dc.description.sponsorshipFundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)-
dc.description.sponsorshipConselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)-
dc.description.sponsorshipFinanciadora de Estudos e Projetos (FINEP)-
dc.description.sponsorshipFukuda Foundation for Medical Technology-
dc.description.sponsorshipTokibo CO-
dc.description.sponsorshipNewport Medical Instruments Inc.-
dc.description.sponsorshipOsaka University-
dc.publisherAMER THORACIC SOC-
dc.relation.ispartofAmerican Journal of Respiratory and Critical Care Medicine-
dc.subjectspontaneous breathing-
dc.subjecttranspulmonary pressure-
dc.subjectpleural pressure-
dc.subjectelectrical impedance tomography-
dc.subject.otheracute lung injury-
dc.subject.otherneuromuscular blocking-agents-
dc.subject.otherpleural surface pressure-
dc.subject.othertranspulmonary pressures-
dc.titleSpontaneous Effort Causes Occult Pendelluft during Mechanical Ventilation-
dc.rights.holderCopyright AMER THORACIC SOC-
dc.subject.wosCritical Care Medicine-
dc.subject.wosRespiratory System-
dc.type.categoryoriginal article-
dc.type.versionpublishedVersion-, Takeshi:Univ Sao Paulo, Fac Med, Lab Pneumol LIM 09, Disciplina Pneumol,Heart Inst Incor,Hosp Clin, BR-01246903 Sao Paulo, Brazil; Osaka Univ, Grad Sch Med, Dept Anesthesiol & Intens Care Med, Suita, Osaka, Japan-, Vinicius:Univ Sao Paulo, Fac Med, Lab Pneumol LIM 09, Disciplina Pneumol,Heart Inst Incor,Hosp Clin, BR-01246903 Sao Paulo, Brazil-, Marcelo A.:Univ Sao Paulo, Fac Med, Lab Pneumol LIM 09, Disciplina Pneumol,Heart Inst Incor,Hosp Clin, BR-01246903 Sao Paulo, Brazil-, Walter A.:Univ Fed Rio de Janeiro, Inst Biofis Carlos Chagas Filho, Rio De Janeiro, Brazil-, Brian P.:Univ Toronto, Hosp Sick Children, Dept Crit Care Med, Toronto, ON M5G 1X8, Canada; Univ Toronto, Hosp Sick Children, Dept Anesthesia, Toronto, ON M5G 1X8, Canada-
hcfmusp.publisher.cityNEW YORK-
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hcfmusp.remissive.sponsorshipFederico Foundation-
Appears in Collections:

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

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