Pulmonary acute respiratory distress syndrome: positive end-expiratory pressure titration needs stress index.

The heterogeneity of lung injury in pulmonary acute respiratory distress syndrome (ARDS) may have contributed to the greater response of hyperinflated area with positive end-expiratory pressure (PEEP). PEEP titrated by stress index can reduce the risk of alveolar hyperinflation in patients with pulmonary ARDS. The authors sought to investigate the effects of PEEP titrated by stress index on lung recruitment and protection after recruitment maneuver (RM) in pulmonary ARDS patients. Thirty patients with pulmonary ARDS were enrolled. After RM, PEEP was randomly set according to stress index, oxygenation, static pulmonary compliance (Cst), or lower inflection point (LIP) + 2 cmH2O strategies. Recruitment volume, gas exchange, respiratory mechanics, and hemodynamic parameters were collected. PEEP titrated by stress index (15.1 ± 1.8 cmH2O) was similar to the levels titrated by oxygenation (14.5 ± 2.9 cmH2O), higher than that titrated by Cst (11.3 ± 2.5 cmH2O) and LIP (12.9 ± 1.6 cmH2O) (P < 0.05). Compared with baseline, PaO2/FiO2 and recruitment volume were significantly improved after PEEP titration with the four strategies (P < 0.05). PaO2/FiO2 and recruitment volume were similar when using PEEP titrated by stress index and oxygenation but higher than that titrated by Cst and LIP. Compared with baseline, lung compliance increased significantly when PEEP determined by Cst, but there was no difference of Cst in these four strategies. There was no influence of PEEP titration with the four strategies on hemodynamic parameters. PEEP titration by stress index might be more beneficial for pulmonary ARDS patients after RM.

Huang Y ，Yang Y ，Chen Q ，Liu S ，Liu L ，Pan C ，Yang C ，Qiu H ... -  《-》

[Effect of lung stress index upon titration of positive end-expiratory pressure at post-recruitment in patients with acute respiratory distress syndrome].

Huang YZ ，Yang Y ，Liu SQ ，Yang CS ，Qiu HB ... -  《-》

Evaluation of a recruitment maneuver with positive inspiratory pressure and high PEEP in patients with severe ARDS.

Póvoa P ，Almeida E ，Fernandes A ，Mealha R ，Moreira P ，Sabino H ... -  《ACTA ANAESTHESIOLOGICA SCANDINAVICA》

Positive end expiratory pressure titrated by transpulmonary pressure improved oxygenation and respiratory mechanics in acute respiratory distress syndrome patients with intra-abdominal hypertension.

Yang Y ，Li Y ，Liu SQ ，Liu L ，Huang YZ ，Guo FM ，Qiu HB ... -  《-》

[Positive end-expiratory pressure and tidal volume titration after recruitment maneuver in a canine model of acute respiratory distress syndrome].

Zhan QY ，Wang C ，Sun B ，Pang BS ... -  《-》