Positive end-expiratory pressure, pleural pressure, and regional compliance during Pronation An Experimental Study

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dc.contributor.authorKatira B.H.
dc.contributor.authorOsada K.
dc.contributor.authorEngelberts D.
dc.contributor.authorBastia L.
dc.contributor.authorDamiani L.F.
dc.contributor.authorLi X.
dc.contributor.authorChan H.
dc.contributor.authorYoshida T.
dc.contributor.authorPost M.
dc.contributor.authorKavanagh B.P.
dc.contributor.authorKatira B.H.
dc.contributor.authorOsada K.
dc.contributor.authorBastia L.
dc.contributor.authorDamiani L.F.
dc.contributor.authorLi X.
dc.contributor.authorChan H.
dc.contributor.authorYoshida T.
dc.contributor.authorFerguson N.D.
dc.contributor.authorKavanagh B.P.
dc.contributor.authorBrochard L.J.
dc.contributor.authorKatira B.H.
dc.contributor.authorPost M.
dc.contributor.authorKavanagh B.P.
dc.contributor.authorKatira B.H.
dc.contributor.authorFerguson N.D.
dc.contributor.authorPost M.
dc.contributor.authorKavanagh B.P.
dc.contributor.authorFerguson N.D.
dc.contributor.authorFerguson N.D.
dc.contributor.authorKavanagh B.P.
dc.contributor.authorKavanagh B.P.
dc.contributor.authorKatira B.H.
dc.contributor.authorBastia L.
dc.contributor.authorDamiani L.F.
dc.contributor.authorLi X.
dc.contributor.authorLi X.
dc.contributor.authorChan H.
dc.contributor.authorYoshida T.
dc.contributor.authorAmato M.B.P.
dc.contributor.authorFerguson N.D.
dc.contributor.authorFerguson N.D.
dc.contributor.authorBrochard L.J.
dc.date.accessioned2024-01-10T12:36:54Z
dc.date.available2024-01-10T12:36:54Z
dc.date.issued2021
dc.description.abstract© 2021 American Thoracic Society. All rights reserved.Rationale: The physiological basis of lung protection and the impact of positive end-expiratory pressure (PEEP) during pronation in acute respiratory distress syndrome are not fully elucidated. Objectives: To compare pleural pressure (Ppl) gradient, ventilation distribution, and regional compliance between dependent and nondependent lungs, and investigate the effect of PEEP during supination and pronation. Methods: We used a two-hit model of lung injury (saline lavage and high-volume ventilation) in 14 mechanically ventilated pigs and studied supine and prone positions. Global and regional lung mechanics including Ppl and distribution of ventilation (electrical impedance tomography) were analyzed across PEEP steps from 20 to 3 cm H2O. Two pigs underwent computed tomography scans: Tidal recruitment and hyperinflation were calculated. Measurements and Main Results: Pronation improved oxygenation, increased Ppl, thus decreasing transpulmonary pressure for any PEEP, and reduced the dorsal ventral pleural pressure gradient at PEEP,10 cm H2O. The distribution of ventilation was homogenized between dependent and nondependent while prone and was less dependent on the PEEP level than while supine. The highest regional compliance was achieved at different PEEP levels in dependent and nondependent regions in supine position (15 and 8 cm H2O), but for similar values in prone position (13 and 12 cm H2O). Tidal recruitment was more evenly distributed (dependent and nondependent), hyperinflation lower, and lungs cephalocaudally longer in the prone position. Conclusions: In this lung injury model, pronation reduces the vertical pleural pressure gradient and homogenizes regional ventilation and compliance between the dependent and nondependent regions. Homogenization is much less dependent on the PEEP level in prone than in supine positon.
dc.description.funderHospital for Sick Children Restracomp Scholarship
dc.description.funderCanadian Institutes of Health Research
dc.fechaingreso.objetodigital2024-05-20
dc.fuente.origenScopus
dc.identifier.doi10.1164/rccm.202007-2957OC
dc.identifier.eissn15354970
dc.identifier.issn15354970 1073449X
dc.identifier.pubmedid33406012
dc.identifier.scopusidSCOPUS_ID:85105015193
dc.identifier.urihttps://doi.org/10.1164/rccm.202007-2957OC
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/76678
dc.information.autorucFacultad de Medicina; Damiani Rebolledo, Luis Felipe; S/I; 237645
dc.language.isoen
dc.nota.accesocontenido parcial
dc.pagina.final1274
dc.pagina.inicio1266
dc.publisherAmerican Thoracic Society
dc.revistaAmerican Journal of Respiratory and Critical Care Medicine
dc.rightsacceso restringido
dc.subjectAcute lung injury
dc.subjectmechanical ventilation
dc.subjectPositioning
dc.subjectTranspulmonary pressure
dc.titlePositive end-expiratory pressure, pleural pressure, and regional compliance during Pronation An Experimental Study
dc.typeartículo
dc.volumen203
sipa.codpersvinculados237645
sipa.indexScopus
sipa.indexPubmed
sipa.trazabilidadCarga SIPA;09-01-2024
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