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Báo cáo y học: "Heterogeneity in ventilation during positive end-expiratory pressure"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Heterogeneity in ventilation during positive end-expiratory pressure. | Tripathi and Pandey Critical Care 2010 14 436 http ccforum.eom content 14 4 436 CRITICAL CARE LETTER L_ Heterogeneity in ventilation during positive end-expiratory pressure Mukesh Tripathi1 2 and Mamta Pandey3 See related commentary by Costa and Amato http ccforum.Com content 14 2 134 and related research by Zhao etal. http ccforum.com content 14 1 R8 We read with interest the commentary Can heterogeneity in ventilation be good 1 and the related article by Zhao and colleagues 2 . We agree with the comments that instead of incremental positive end-expiratory pressure PEEP levels a decremented PEEP titration might be an attractive option for determining optimal PEEP 1 3 . However we feel that physiological inhomogeneity in ventilation and perfusion related to the gravitational effect in normal lungs occurs during spontaneous breathing and during spontaneous breathing a negative alveolar pressure develops during inspiration and facilitates pulmonary blood flow. Contrary to when applying PEEP the positive pressure remains throughout respiration and paradoxically affects the pulmonary flow. We feel that it would be wiser not to compare the physiological inhomogeneity in ventilation with PEEP-related inhomogenous ventilation. PEEP is a slow recruitment technique for aerating collapsed alveoli which can happen in a non-uniform fashion. Hence anticipating any good effe ct of inhomogeneity of ventilation during PEEP may give a false impression to physicians regarding mechanically ventilated patients in the ICU. Respiratory parameters such as lung mechanics and arterial blood gas reflect global ventilation. The readily available bedside chest X-ray is useful to map the inhomogeneity of the alveolar recruitment during PEEP in acute respiratory distress syndrome patients. The lung infiltration score for the different lung zones can map heterogeneity in lung recruitment 4 . This heterogeneity between the two lungs lung infiltration score difference 3 was associated with .