tailieunhanh - Báo cáo y học: "Can heterogeneity in ventilation be good"

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: Can heterogeneity in ventilation be good? | Costa and Amato Critical Care 2010 14 134 http content 14 2 134 CRITICAL CARE COMMENTARY L__ Can heterogeneity in ventilation be good Eduardo LV Costa - 2 and Marcelo BP Amato 2 See related research by Zhao http content 4 R8 Abstract Selection of the optimal positive end-expiratory pressure PEEP to avoid ventilator-induced lung injury in patients under mechanical ventilation is still a matter of debate. Many methods are available but none is considered the gold standard. In the previous issue of Critical Care Zhao and colleagues applied a method based on electrical impedance tomography to help select the PEEP that minimized ventilation inhomogeneities. Though promising when alveolar collapse and overdistension are present this method might be misleading in patients with normal lungs. In the previous issue of Critical Care Zhao and colleagues 1 applied a method based on electrical impedance tomography EIT to help select the positive end-expiratory pressure PEEP that minimized ventilation inhomogeneities in healthy lungs. Several methods including those based on global mechanics 2 3 arterial blood gases 4 x-ray computerized tomography CT 5 and EIT 6 7 have been proposed to select the best PEEP in patients under mechanical ventilation. Each of these methods has advantages and disadvantages and none is considered the gold standard. Lung compliance for example is the result of an interplay between overdistension and lung collapse. Not infrequently in PEEP versus compliance curves the relief of overdistension after a PEEP reduction overshadows the appearance of massive lung collapse. Conversely CT provides excellent anatomical resolution and allows precise quantification of lung collapse but with the inconveniences of using ionizing radiation and requiring that patients be transferred out of the intensive care unit. EIT has a lower spatial resolution but is radiation-free and can be used at the bedside for prolonged periods of .