OBJECTIVES: To investigate respiratory and hemodynamic changes during lung recruitment and descending optimal positive end-expiratory pressure (PEEP) titration. DESIGN: Prospective auto-control clinical trial. SETTING: Adult general intensive care unit in a university hospital. @entity1 : Eighteen @entity1 with acute @entity649 . INTERVENTIONS: Following baseline measurements (T0), PEEP was set at 26 cm @entity2507 and lung recruitment was performed (40/40-maneuver). Then tidal volume was set at 4 mL/kg ( @entity70521 ) and PEEP was lowered by 2 cm @entity2507 in every 4 mins. Optimal PEEP was defined at 2 cm @entity2507 above the PEEP where Pao2 dropped by > 10%. After setting the optimal PEEP, the 40/40-maneuver was repeated and tidal volume set at 6 mL/kg (T(end)). MEASUREMENTS AND MAIN RESULTS: Arterial blood gas analysis was done every 4 mins and hemodynamic measurements every 8 mins until T(end), then in 30 (T30) and 60 (T60) mins. The Pao2 increased from T0 to T(end) (203 +/- 108 vs. 322 +/- 101 mm Hg, p < .001), but the extravascular lung water (EVLW) did not change significantly. Cardiac index (CI) and the intrathoracic blood volume (ITBV) decreased from T0 to @entity70521 (CI, 3.90 +/- 1.04 vs. 3.62 +/- 0.91 L/min/m2, p < .05; ITBVI, 832 +/- 205 vs. 795 +/- 188 m/m2, p < .05). There was a positive correlation between CI and ITBVI (r = .699, p < .01), a negative correlation between CI and central venous pressure (r = -.294, p < .01), and no correlation between CI and mean arterial pressure (MAP). CONCLUSIONS: Following lung recruitment and descending optimal PEEP titration, the Pao2 improves significantly, without any change in the EVLW up to 1 hr. This suggests a @entity891 as a result of recruitment rather than a reduction of EVLW. There is a significant change in CI during the maneuver, but neither central venous pressure, heart rate, nor MAP can reflect these changes.

Hemodynamic and respiratory changes during lung recruitment and descending optimal positive end-expiratory pressure titration in @entity1 with acute XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'PATIENTS'] @entity649 :: ('MESH:D012128', 'Disease') :: ['respiratory distress syndrome'] @entity891 :: ('MESH:D001261', 'Disease') :: ['decrease in atelectasis'] @entity2507 :: ('CHEBI:33813', 'Chemical') :: ['H2O'] @entity70521 :: ('p|SUB|T|26|R', 'ProteinMutation') :: ['T26R']
@entity649 :: (MESH:D012128,Disease) :: ['respiratory distress syndrome']
