Lung Recruitment in Obese Patients with Acute Respiratory Distress Syndrome Article Swipe
Jacopo Fumagalli
,
Roberta Ribeiro De Santis Santiago
,
Maddalena Teggia Droghi
,
Changsheng Zhang
,
Florian J. Fintelmann
,
Fabian M. Troschel
,
Caio C. A. Morais
,
Marcelo B. P. Amato
,
Robert M. Kacmarek
,
Lorenzo Berra
·
YOU?
·
· 2019
· Open Access
·
· DOI: https://doi.org/10.1097/aln.0000000000002638
YOU?
·
· 2019
· Open Access
·
· DOI: https://doi.org/10.1097/aln.0000000000002638
Editor’s Perspective What We Already Know about This Topic Obesity increases the propensity to atelectasis in acute respiratory distress syndrome, but the optimal approach to reversing this atelectasis is uncertain What This Article Tells Us That Is New A clinical crossover study comparing three approaches to titrate positive end-expiratory pressure (PEEP; according to a fixed table, according to end-expiratory esophageal pressure, and targeting the best compliance during a decremental PEEP trial) found that a recruitment maneuver followed by decremental PEEP minimized atelectasis and overdistension, and best restored compliance and oxygenation without causing hemodynamic impairment Background Obese patients are characterized by normal chest-wall elastance and high pleural pressure and have been excluded from trials assessing best strategies to set positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome (ARDS). The authors hypothesized that severely obese patients with ARDS present with a high degree of lung collapse, reversible by titrated PEEP preceded by a lung recruitment maneuver. Methods Severely obese ARDS patients were enrolled in a physiologic crossover study evaluating the effects of three PEEP titration strategies applied in the following order: (1) PEEP ARDSNET : the low PEEP/F io 2 ARDSnet table; (2) PEEP INCREMENTAL : PEEP levels set to determine a positive end-expiratory transpulmonary pressure; and (3) PEEP DECREMENTAL : PEEP levels set to determine the lowest respiratory system elastance during a decremental PEEP trial following a recruitment maneuver on respiratory mechanics, regional lung collapse, and overdistension according to electrical impedance tomography and gas exchange. Results Fourteen patients underwent the study procedures. At PEEP ARDSNET (13 ± 1 cm H 2 O) end-expiratory transpulmonary pressure was negative (−5 ± 5 cm H 2 O), lung elastance was 27 ± 12 cm H 2 O/L, and PaO 2 /F io 2 was 194 ± 111 mmHg. Compared to PEEP ARDSNET , at PEEP INCREMENTAL level (22 ± 3 cm H 2 O) lung volume increased (977 ± 708 ml), lung elastance decreased (23 ± 7 cm H 2 O/l), lung collapse decreased (18 ± 10%), and ventilation homogeneity increased thus rising oxygenation (251 ± 105 mmHg), despite higher overdistension levels (16 ± 12%), all values P < 0.05 versus PEEP ARDSnet . Setting PEEP according to a PEEP DECREMENTAL trial after a recruitment maneuver (21 ± 4 cm H 2 O, P = 0.99 vs. PEEP INCREMENTAL ) further lowered lung elastance (19 ± 6 cm H 2 O/l) and increased oxygenation (329 ± 82 mmHg) while reducing lung collapse (9 ± 2%) and overdistension (11 ± 2%), all values P < 0.05 versus PEEP ARDSnet and PEEP INCREMENTAL . All patients were maintained on titrated PEEP levels up to 24 h without hemodynamic or ventilation related complications. Conclusions Among the PEEP titration strategies tested, setting PEEP according to a PEEP DECREMENTAL trial preceded by a recruitment maneuver obtained the best lung function by decreasing lung overdistension and collapse, restoring lung elastance, and oxygenation suggesting lung tissue recruitment.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1097/aln.0000000000002638
- https://anesthesiology.pubs.asahq.org/jasa/content_public/journal/jasa/937953/20190500.0-00025.pdf
- OA Status
- bronze
- Cited By
- 94
- References
- 41
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W2922357684
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W2922357684Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1097/aln.0000000000002638Digital Object Identifier
- Title
-
Lung Recruitment in Obese Patients with Acute Respiratory Distress SyndromeWork title
- Type
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articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
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2019Year of publication
- Publication date
-
2019-03-14Full publication date if available
- Authors
-
Jacopo Fumagalli, Roberta Ribeiro De Santis Santiago, Maddalena Teggia Droghi, Changsheng Zhang, Florian J. Fintelmann, Fabian M. Troschel, Caio C. A. Morais, Marcelo B. P. Amato, Robert M. Kacmarek, Lorenzo BerraList of authors in order
- Landing page
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https://doi.org/10.1097/aln.0000000000002638Publisher landing page
- PDF URL
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https://anesthesiology.pubs.asahq.org/jasa/content_public/journal/jasa/937953/20190500.0-00025.pdfDirect link to full text PDF
- Open access
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YesWhether a free full text is available
- OA status
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bronzeOpen access status per OpenAlex
- OA URL
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https://anesthesiology.pubs.asahq.org/jasa/content_public/journal/jasa/937953/20190500.0-00025.pdfDirect OA link when available
- Concepts
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Medicine, Acute respiratory distress, Respiratory distress, Intensive care medicine, Lung, Diffuse alveolar damage, Respiratory system, Internal medicine, AnesthesiaTop concepts (fields/topics) attached by OpenAlex
- Cited by
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94Total citation count in OpenAlex
- Citations by year (recent)
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2025: 13, 2024: 13, 2023: 10, 2022: 11, 2021: 22Per-year citation counts (last 5 years)
- References (count)
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41Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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| primary_location.pdf_url | https://anesthesiology.pubs.asahq.org/jasa/content_public/journal/jasa/937953/20190500.0-00025.pdf |
| primary_location.version | publishedVersion |
| primary_location.raw_type | journal-article |
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| primary_location.raw_source_name | Anesthesiology |
| primary_location.landing_page_url | https://doi.org/10.1097/aln.0000000000002638 |
| publication_date | 2019-03-14 |
| publication_year | 2019 |
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