tailieunhanh - Báo cáo y học: "Commonly applied positive end-expiratory pressures do not prevent functional residual capacity decline in the setting of intra-abdominal hypertension: a pig model"

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: Commonly applied positive end-expiratory pressures do not prevent functional residual capacity decline in the setting of intra-abdominal hypertension: a pig model. | Regli et al. Critical Care 2010 14 R128 http content 14 4 R128 c CRITICAL CARE RESEARCH Open Access Commonly applied positive end-expiratory pressures do not prevent functional residual capacity decline in the setting of intra-abdominal hypertension a pig model 1 1 2 1 3 3 Adrian Regli Lisen E Hockings Gabrielle C Musk Brigit Roberts Bill Noffsinger Bhajan Singh Peter V van Heerden1 Abstract Introduction Intra-abdominal hypertension is common in critically ill patients and is associated with increased morbidity and mortality. The optimal ventilation strategy remains unclear in these patients. We examined the effect of positive end-expiratory pressures PEEP on functional residual capacity FRC and oxygen delivery in a pig model of intra-abdominal hypertension. Methods Thirteen adult pigs received standardised anaesthesia and ventilation. We randomised three levels of intra-abdominal pressure 3 mmHg baseline 18 mmHg and 26 mmHg and four commonly applied levels of PEEP 5 8 12 and 15 cmH2O . Intra-abdominal pressures were generated by inflating an intra-abdominal balloon. We measured intra-abdominal bladder pressure functional residual capacity cardiac output haemoglobin and oxygen saturation and calculated oxygen delivery. Results Raised intra-abdominal pressure decreased FRC but did not change cardiac output. PEEP increased FRC at baseline intra-abdominal pressure. The decline in FRC with raised intra-abdominal pressure was partly reversed by PEEP at 18 mmHg intra-abdominal pressure and not at all at 26 mmHg intra-abdominal pressure. PEEP significantly decreased cardiac output and oxygen delivery at baseline and at 26 mmHg intra-abdominal pressure but not at 18 mmHg intra-abdominal pressure. Conclusions In a pig model of intra-abdominal hypertension PEEP up to 15 cmH2O did not prevent the FRC decline caused by intra-abdominal hypertension and was associated with reduced oxygen delivery as a consequence of reduced cardiac output. This implies that PEEP .