Repeated Derecruitments Accentuate Lung Injury During Mechanical Ventilation

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dc.contributor.authorPark, Hye Yunko
dc.contributor.authorHa, Sang Yunko
dc.contributor.authorLee, Shin Hyeko
dc.contributor.authorKim, Sajiko
dc.contributor.authorChang, Keun Sickko
dc.contributor.authorJeon, Kyeongmanko
dc.contributor.authorUm, Sang-Wonko
dc.contributor.authorKoh, Won-Jungko
dc.contributor.authorSuh, Gee Youngko
dc.contributor.authorChung, Man Pyoko
dc.contributor.authorHan, Jounghoko
dc.contributor.authorKim, Hojoongko
dc.contributor.authorKwon, O. Jungko
dc.date.accessioned2016-04-05T15:30:52Z-
dc.date.available2016-04-05T15:30:52Z-
dc.date.created2014-07-10-
dc.date.created2014-07-10-
dc.date.issued2013-12-
dc.identifier.citationCRITICAL CARE MEDICINE, v.41, no.12, pp.423 - 430-
dc.identifier.issn0090-3493-
dc.identifier.urihttp://hdl.handle.net/10203/202767-
dc.description.abstractObjectives: The aim of our study was to assess whether repeated derecruitments induced by the repetitive withdrawal of high positive end-expiratory pressure could induce lung injury in a swine model. Design: Prospective, randomized, experimental animal study. Setting: University laboratory. Subjects: Specific pathogen-free pigs (Choong-Ang Laboratory Animals, Seoul, Korea) weighing around 30 kg. Interventions: After lung injury was induced by repeated saline lavage, pigs were ventilated in pressure-limited mode with the highest possible positive end-expiratory pressure with a tidal volume of 8 mL/kg and maximum inspiratory pressure of 30 cm H2O. With this initial ventilator setting, the control group (n = 5) received ventilation without derecruitments for 4 hours, and in the derecruitment group (n = 5), derecruitments were repeatedly induced by intentional disconnection of the ventilatory circuit for 30 seconds every 5 minutes for 4 hours. Measurements and Main Results: After the initial increase in positive end-expiratory pressure, the PaO2 increased to greater than 450 mm Hg in both groups. The PaO2 remained at greater than 450 mm Hg in the control group persistently, but in the derecruitment group, PaO2 significantly decreased to 427.7 mm Hg (adjusted p = 0.03) after 2 hours and remained significant for the rest of the study. PaCO2, oxygenation index, and alveolar-arterial oxygen gradient also significantly increased after 2 hours compared with the control group. However, the variables of respiratory mechanics except for minute volume at 2-hour point showed no difference between the two groups for the duration of the study. Histologically, significant bronchiolar injury was observed in the dependent portion of the derecruitment group compared with the controls (p = 0.03), but not in the nondependent area of the lung. Conclusions: Repeated derecruitments exacerbated lung injury, particularly at the bronchiolar level in the dependent portion. Strategies to minimize this type of injury should be incorporated when designing optimal ventilator strategies in acute respiratory distress syndrome patients.-
dc.languageEnglish-
dc.publisherLIPPINCOTT WILLIAMS & WILKINS-
dc.subjectRESPIRATORY-DISTRESS-SYNDROME-
dc.subjectEND-EXPIRATORY PRESSURE-
dc.subjectCYCLICAL AIRWAY COLLAPSE-
dc.subjectPRONE POSITION-
dc.subjectLOW-VOLUME-
dc.subjectFAILURE-
dc.subjectHETEROGENEITY-
dc.subjectRECRUITMENT-
dc.subjectTOMOGRAPHY-
dc.subjectMORTALITY-
dc.titleRepeated Derecruitments Accentuate Lung Injury During Mechanical Ventilation-
dc.typeArticle-
dc.identifier.wosid000330539100003-
dc.identifier.scopusid2-s2.0-84889256808-
dc.type.rimsART-
dc.citation.volume41-
dc.citation.issue12-
dc.citation.beginningpage423-
dc.citation.endingpage430-
dc.citation.publicationnameCRITICAL CARE MEDICINE-
dc.identifier.doi10.1097/CCM.0b013e3182986268-
dc.contributor.localauthorChang, Keun Sick-
dc.contributor.nonIdAuthorPark, Hye Yun-
dc.contributor.nonIdAuthorHa, Sang Yun-
dc.contributor.nonIdAuthorLee, Shin Hye-
dc.contributor.nonIdAuthorJeon, Kyeongman-
dc.contributor.nonIdAuthorUm, Sang-Won-
dc.contributor.nonIdAuthorKoh, Won-Jung-
dc.contributor.nonIdAuthorSuh, Gee Young-
dc.contributor.nonIdAuthorChung, Man Pyo-
dc.contributor.nonIdAuthorHan, Joungho-
dc.contributor.nonIdAuthorKim, Hojoong-
dc.contributor.nonIdAuthorKwon, O. Jung-
dc.type.journalArticleArticle-
dc.subject.keywordAuthoracute lung injury-
dc.subject.keywordAuthoralveolar collapse-
dc.subject.keywordAuthorbronchiole-
dc.subject.keywordAuthormechanical ventilation-
dc.subject.keywordAuthorpig-
dc.subject.keywordAuthorpositive end-expiratory pressure-
dc.subject.keywordPlusRESPIRATORY-DISTRESS-SYNDROME-
dc.subject.keywordPlusEND-EXPIRATORY PRESSURE-
dc.subject.keywordPlusCYCLICAL AIRWAY COLLAPSE-
dc.subject.keywordPlusPRONE POSITION-
dc.subject.keywordPlusLOW-VOLUME-
dc.subject.keywordPlusFAILURE-
dc.subject.keywordPlusHETEROGENEITY-
dc.subject.keywordPlusRECRUITMENT-
dc.subject.keywordPlusTOMOGRAPHY-
dc.subject.keywordPlusMORTALITY-
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