Department of Pulmonary and Critical Care Medicine, Inje University Ilsan Paik Hospital, Goyang-si, Korea.
Crit Care. 2009;13(1):R22. doi: 10.1186/cc7725. Epub 2009 Feb 24.
In acute respiratory distress syndrome (ARDS), adequate positive end-expiratory pressure (PEEP) may decrease ventilator-induced lung injury by minimising overinflation and cyclic recruitment-derecruitment of the lung. We evaluated whether setting the PEEP using decremental PEEP titration after an alveolar recruitment manoeuvre (ARM) affects the clinical outcome in patients with ARDS.
Fifty-seven patients with early ARDS were randomly assigned to a group given decremental PEEP titration following ARM or a table-based PEEP (control) group. PEEP and inspired fraction of oxygen (FiO2) in the control group were set according to the table-based combinations of FiO2 and PEEP of the ARDS network, by which we aimed to achieve a PEEP level compatible with an oxygenation target. In the decremental PEEP titration group, the oxygen saturation and static compliance were monitored as the patients performed the ARM along with the extended sigh method, which is designed to gradually apply and withdraw a high distending pressure over a prolonged period, and the decremental titration of PEEP.
The baseline characteristics did not differ significantly between the control and decremental PEEP titration groups. Initial oxygenation improved more in the decremental PEEP titration group than in the control group. However, dynamic compliance, tidal volume and PEEP were similar in the two groups during the first week. The duration of use of paralysing or sedative agents, mechanical ventilation, stay in the intensive care unit and mortality at 28 days did not differ significantly between the decremental PEEP titration and control groups.
The daily decremental PEEP titration after ARM showed only initial oxygenation improvement compared with the table-based PEEP method. Respiratory mechanics and patient outcomes did not differ between the decremental PEEP titration and control groups.
ClinicalTrials.gov identifier: ISRCTN79027921.
在急性呼吸窘迫综合征（ARDS）中，通过最小化过度充气和肺的周期性复张-去复张，适当的呼气末正压（PEEP）可减少呼吸机所致肺损伤。我们评估了在肺复张手法（ARM）后使用递减 PEEP 滴定来设置 PEEP 是否会影响 ARDS 患者的临床结局。
57 例早期 ARDS 患者随机分为 ARM 后给予递减 PEEP 滴定组或基于表格的 PEEP（对照组）。对照组中 PEEP 和吸入氧分数（FiO2）根据 ARDS 网络的 FiO2 和 PEEP 表格组合设定，目的是达到与氧合目标兼容的 PEEP 水平。在递减 PEEP 滴定组中，随着患者进行 ARM 和扩展叹气法，监测氧饱和度和静态顺应性，扩展叹气法旨在在延长的时间内逐渐施加和撤回高膨胀压力，同时进行递减 PEEP 滴定。
对照组和递减 PEEP 滴定组的基线特征无显著差异。递减 PEEP 滴定组初始氧合改善更明显。然而，两组在第一周期间的动态顺应性、潮气量和 PEEP 相似。两组中使用肌松或镇静剂、机械通气、入住重症监护病房和 28 天死亡率无显著差异。
与基于表格的 PEEP 方法相比，ARM 后每日递减 PEEP 滴定仅显示初始氧合改善。递减 PEEP 滴定组和对照组的呼吸力学和患者结局无差异。
ClinicalTrials.gov 标识符：ISRCTN79027921。
