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Influence of lung collapse distribution on the physiologic response to recruitment maneuvers during noninvasive continuous positive airway pressure

Gianmaria Cammarota| Rosanna Vaschetto| Emilia Turucz| Fabrizio Dellapiazza| Davide Colombo| Cristiana Blando| Francesco Della Corte| Salvatore Maurizio Maggiore| Paolo Navalesi
Original
Volume 37, Issue 7 / July , 2011

Pages 1095 - 1102

Abstract

Purpose

Noninvasive continuous positive airway pressure (n-CPAP) has been proposed for the treatment of hypoxemic acute respiratory failure (h-ARF). Recruitment maneuvers were shown to improve oxygenation, i.e., the ratio of arterial oxygen tension to inspiratory oxygen fraction (PaO2/FiO2), during either invasive mechanical ventilation, and n-CPAP, with a response depending on the distribution of lung collapse. We hypothesized that, during n-CPAP, early h-ARF patients with bilateral (BL) distribution of lung involvement would benefit from recruitment maneuvers more than those with unilateral (UL) involvement.

Methods

To perform a recruitment maneuver, once a minute we increased the pressure applied to the airway from 10 cmH2O to 25 cmH2O for 8 s (SIGH). We enrolled 24 patients with h-ARF (12 BL and 12 UL) who underwent four consecutive trials: (1) 30 min breathing through a Venturi mask (VMASK), (2) 1 h n-CPAP (n-CPAP1), (3) 1 h n-CPAP plus SIGH (n-CPAPSIGH), and (4) 1 h n-CPAP (n-CPAP2).

Results

Compared to VMASK, n-CPAP at 10 cmH2O delivered via a helmet, increased PaO2/FiO2 and decreased dyspnea in both BL and UL; furthermore, it reduced the respiratory rate and brought PaCO2 up to normal in BL only. Compared to n-CPAP, n-CPAPSIGH significantly improved PaO2/FiO2 in BL (225 ± 88 vs. 308 ± 105, respectively), whereas it produced no further improvement in PaO2/FiO2 in UL (232 ± 72 vs. 231 ± 77, respectively). SIGH did not affect hemodynamics in both groups.

Conclusions

Compared to n-CPAP, n-CPAPSIGH further improved arterial oxygenation in BL patients, whereas it produced no additional benefit in those with UL.

Keywords

References

  1. Lindner KH, Lotz P, Ahnefeld FW (1987) Continuous positive airway pressure effect on functional residual capacity, vital capacity and its subdivisions. Chest 92:66–70
    • View reference on PubMed
    • View reference on publisher's website
  2. Lenique F, Habis M, Lofaso F, Dubois-Rande JL, Harf A, Brochard L (1997) Ventilatory and hemodynamic effects of continuous positive airway pressure in left heart failure. Am J Respir Crit Care Med 155:500–505
    • View reference on PubMed
  3. Cabrini L, Idone C, Colombo S, Monti G, Bergonzi PC, Landoni G, Salaris D, Leggieri C, Torri G (2009) Medical emergency team and non-invasive ventilation outside ICU for acute respiratory failure. Intensive Care Med 35:339–343
  4. Foti G, Sangalli F, Berra L, Sironi S, Cazzaniga M, Rossi GP, Bellani G, Pesenti A (2009) Is helmet CPAP first line pre-hospital treatment of presumed severe acute pulmonary edema? Intensive Care Med 35:656–662
  5. Gray AJ, Goodacre S, Newby DE, Masson MA, Sampson F, Dixon S, Crane S, Elliott M, Nicholl J (2009) A multicentre randomised controlled trial of the use of continuous positive airway pressure and non-invasive positive pressure ventilation in the early treatment of patients presenting to the emergency department with severe acute cardiogenic pulmonary oedema: the 3CPO trial. Health Technol Assess 13:1–106
  6. Principi T, Pantanetti S, Catani F, Elisei D, Gabbanelli V, Pelaia P, Leoni P (2004) Noninvasive continuous positive airway pressure delivered by helmet in hematological malignancy patients with hypoxemic acute respiratory failure. Intensive Care Med 30:147–150
  7. Templier F, Dolveck F, Baer M, Chauvin M, Fletcher D (2003) ‘Boussignac’ continuous positive airway pressure system: practical use in a prehospital medical care unit. Eur J Emerg Med 10:87–93
    • View reference on PubMed
    • View reference on publisher's website
  8. Nava S, Navalesi P, Gregoretti C (2009) Interfaces and humidification for noninvasive mechanical ventilation. Respir Care 54:71–84
    • View reference on PubMed
  9. Tonnelier JM, Prat G, Nowak E, Goetghebeur D, Renault A, Boles JM, L’Her E (2003) Noninvasive continuous positive airway pressure ventilation using a new helmet interface: a case-control prospective pilot study. Intensive Care Med 29:2077–2080
  10. Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J (2008) Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 359:142–151
    • View reference on PubMed
    • View reference on publisher's website
  11. Masip J, Roque M, Sanchez B, Fernandez R, Subirana M, Exposito JA (2005) Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA 294:3124–3130
    • View reference on PubMed
    • View reference on publisher's website
  12. Mehta S, Al-Hashim AH, Keenan SP (2009) Noninvasive ventilation in patients with acute cardiogenic pulmonary edema. Respir Care 54:186–195
    • View reference on PubMed
  13. Carlsson C, Sonden B, Thylen U (1981) Can postoperative continuous positive airway pressure (CPAP) prevent pulmonary complications after abdominal surgery? Intensive Care Med 7:225–229
  14. Ricksten SE, Bengtsson A, Soderberg C, Thorden M, Kvist H (1986) Effects of periodic positive airway pressure by mask on postoperative pulmonary function. Chest 89:774–781
    • View reference on PubMed
    • View reference on publisher's website
  15. Squadrone V, Coha M, Cerutti E, Schellino MM, Biolino P, Occella P, Belloni G, Vilianis G, Fiore G, Cavallo F, Ranieri VM (2005) Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA 293:589–595
    • View reference on PubMed
    • View reference on publisher's website
  16. Delclaux C, L’Her E, Alberti C, Mancebo J, Abroug F, Conti G, Guerin C, Schortgen F, Lefort Y, Antonelli M, Lepage E, Lemaire F, Brochard L (2000) Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: a randomized controlled trial. JAMA 284:2352–2360
    • View reference on PubMed
    • View reference on publisher's website
  17. L’Her E, Deye N, Lellouche F, Taille S, Demoule A, Fraticelli A, Mancebo J, Brochard L (2005) Physiologic effects of noninvasive ventilation during acute lung injury. Am J Respir Crit Care Med 172:1112–1118
    • View reference on PubMed
    • View reference on publisher's website
  18. Pelosi P, Cadringher P, Bottino N, Panigada M, Carrieri F, Riva E, Lissoni A, Gattinoni L (1999) Sigh in acute respiratory distress syndrome. Am J Respir Crit Care Med 159:872–880
    • View reference on PubMed
  19. Patroniti N, Foti G, Cortinovis B, Maggioni E, Bigatello LM, Cereda M, Pesenti A (2002) Sigh improves gas exchange and lung volume in patients with acute respiratory distress syndrome undergoing pressure support ventilation. Anesthesiology 96:788–794
    • View reference on PubMed
    • View reference on publisher's website
  20. Isgro S, Zanella A, Sala C, Grasselli G, Foti G, Pesenti A, Patroniti N (2010) Continuous flow biphasic positive airway pressure by helmet in patients with acute hypoxic respiratory failure: effect on oxygenation. Intensive Care Med 36:1688–1694
  21. Constantin JM, Grasso S, Chanques G, Aufort S, Futier E, Sebbane M, Jung B, Gallix B, Bazin JE, Rouby JJ, Jaber S (2010) Lung morphology predicts response to recruitment maneuver in patients with acute respiratory distress syndrome. Crit Care Med 38:1108–1117
    • View reference on PubMed
    • View reference on publisher's website
  22. Aviram G, Bar-Shai A, Sosna J, Rogowski O, Rosen G, Weinstein I, Steinvil A, Zimmerman O (2010) H1N1 influenza: initial chest radiographic findings in helping predict patient outcome. Radiology 255:252–259
    • View reference on PubMed
    • View reference on publisher's website
  23. Chong S, Lee KS, Kim TS, Chung MJ, Chung MP, Han J (2006) Adenovirus pneumonia in adults: radiographic and high-resolution CT findings in five patients. AJR Am J Roentgenol 186:1288–1293
    • View reference on PubMed
    • View reference on publisher's website
  24. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology 246:697–722
    • View reference on PubMed
    • View reference on publisher's website
  25. Aitken RC (1969) Measurement of feelings using visual analogue scales. Proc R Soc Med 62:989–993
    • View reference on PubMed
  26. Fan E, Wilcox ME, Brower RG, Stewart TE, Mehta S, Lapinsky SE, Meade MO, Ferguson ND (2008) Recruitment maneuvers for acute lung injury: a systematic review. Am J Respir Crit Care Med 178:1156–1163
    • View reference on PubMed
    • View reference on publisher's website
  27. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829
    • View reference on PubMed
    • View reference on publisher's website
  28. Murray JF, Matthay MA, Luce JM, Flick MR (1988) An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 138:720–723
    • View reference on PubMed
  29. Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G (1993) Re-expansion of atelectasis during general anaesthesia: a computed tomography study. Br J Anaesth 71:788–795
    • View reference on PubMed
    • View reference on publisher's website
  30. Winans CS (1972) The pharyngoesophageal closure mechanism: a manometric study. Gastroenterology 63:768–777
    • View reference on PubMed
  31. Ho-Tai LM, Devitt JH, Noel AG, O’Donnell MP (1998) Gas leak and gastric insufflation during controlled ventilation: face mask versus laryngeal mask airway. Can J Anaesth 45:206–211
    • View reference on PubMed
    • View reference on publisher's website
  32. Vyas H, Milner AD, Hopkin IE (1983) Face mask resuscitation: does it lead to gastric distension? Arch Dis Child 58:373–375
    • View reference on PubMed
    • View reference on publisher's website
  33. Brochard L, Isabey D, Piquet J, Amaro P, Mancebo J, Messadi AA, Brun-Buisson C, Rauss A, Lemaire F, Harf A (1990) Reversal of acute exacerbations of chronic obstructive lung disease by inspiratory assistance with a face mask. N Engl J Med 323:1523–1530
    • View reference on PubMed
    • View reference on publisher's website
  34. Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, Russo S, Patroniti N, Cornejo R, Bugedo G (2006) Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 354:1775–1786
    • View reference on PubMed
    • View reference on publisher's website
  35. Grasso S, Stripoli T, De MM, Bruno F, Moschetta M, Angelelli G, Munno I, Ruggiero V, Anaclerio R, Cafarelli A, Driessen B, Fiore T (2007) ARDSnet ventilatory protocol and alveolar hyperinflation: role of positive end-expiratory pressure. Am J Respir Crit Care Med 176:761–767
    • View reference on PubMed
    • View reference on publisher's website
  36. Vieira SR, Puybasset L, Lu Q, Richecoeur J, Cluzel P, Coriat P, Rouby JJ (1999) A scanographic assessment of pulmonary morphology in acute lung injury. Significance of the lower inflection point detected on the lung pressure-volume curve. Am J Respir Crit Care Med 159:1612–1623
    • View reference on PubMed
  37. Pesenti A, Rossi N, Calori A, Foti G, Rossi GP (1993) Effects of short-term oxygenation changes on acute lung injury patients undergoing pressure support ventilation. Chest 103:1185–1189
    • View reference on PubMed
    • View reference on publisher's website
  38. Cereda M, Foti G, Marcora B, Gili M, Giacomini M, Sparacino ME, Pesenti A (2000) Pressure support ventilation in patients with acute lung injury. Crit Care Med 28:1269–1275
    • View reference on PubMed
    • View reference on publisher's website
  39. Jones HA, Turner SL, Hughes JM (1984) Performance of the large-reservoir oxygen mask (Ventimask). Lancet 1:1427–1431
    • View reference on PubMed
    • View reference on publisher's website
  40. Antonelli M, Conti G, Bufi M, Costa MG, Lappa A, Rocco M, Gasparetto A, Meduri GU (2000) Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA 283:235–241
    • View reference on PubMed
    • View reference on publisher's website
  41. Antonelli M, Conti G, Rocco M, Arcangeli A, Cavaliere F, Proietti R, Meduri GU (2002) Noninvasive positive-pressure ventilation vs. conventional oxygen supplementation in hypoxemic patients undergoing diagnostic bronchoscopy. Chest 121:1149–1154
    • View reference on PubMed
    • View reference on publisher's website
  42. Rouby JJ, Puybasset L, Nieszkowska A, Lu Q (2003) Acute respiratory distress syndrome: lessons from computed tomography of the whole lung. Crit Care Med 31:S285–S295
    • View reference on PubMed
    • View reference on publisher's website

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