Sigh in Acute Respiratory Failure

  • N. Patroniti
  • G. Foti
  • A. Pesenti

Abstract

Mechanical ventilation, a cornerstone in the management of patients affected by acute respiratory failure, has undergone progressive and profound changes through the last 30 years. In the ’70s, tidal volumes (VT) as high as 10–15 ml/kg and elevated plateau pressures were routinely applied in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS); apart from hypocapnia, no other major side effect was recognized at that time [1]. Positive end-expiratory pressure (PEEP) was already in use to enhance alveolar recruitment, targeted to optimize respiratory mechanics, gas exchange, and hemodynamics [2]. High VT could help in providing adequate arterial oxygenation at the lowest PEEP and inspired oxygen fraction (FiO2), considered to be the most important damaging factor for diseased lungs [3]. By the late ’80s, many authors had described animal models of ventilator-induced lung injury (VILI), showing how high airway pressure could induce severe lung injury [4] and histopathological findings strikingly similar to those of patients treated by injurious ventilation (ventilator lung) [5]. Subsequent studies identified the high transalveolar distending pressure (volu-barotrauma) [6] as a possible mechanism for lung rupture, fractures of epithelium and basement membrane [7]. More recent trials suggested that an intense inflammatory response (biotrauma) could be elicited by parenchymal stretching, and that high levels of cytokines could be found both in plasma and bronchoalveolar (BAL) fluid during high volume ventilation [8], though other studies applying similar experimental settings found that a lung injured by high VT ventilation does not cause, per se, a significant release of pro-inflammatory cytokines into the airspaces or the systemic circulation [9].

Keywords

Acute Lung Injury Acute Respiratory Distress Syndrome Acute Respiratory Failure Respir Crit Acute Respiratory Distress Syndrome Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Pontoppidan H, Geffin B, Lowentin (1972) Acute respiratory failure in the adult. N Engl J Med 287: 799–806Google Scholar
  2. 2.
    Suter PM, Fairley HB, Isenberg MD (1978) Effect of tidal volume and end-expiratory pressure on compliance during mechanical ventilation. Chest 73: 158–162PubMedCrossRefGoogle Scholar
  3. 3.
    Nash G, Bowen JA, Langlinais PC (1971) Respirator lung: a misnomer. Arch Path 21: 234–240Google Scholar
  4. 4.
    Kolobow T, Moretti MP, Fumagalli R, et al (1987) Severe impairment in lung function induced high peak airway pressure during mechanical ventilation: an experimental study. Am Rev Respir Dis 135: 312–315PubMedGoogle Scholar
  5. 5.
    Rouby JJ, Lherm T, Martin de Lassai E, et al (1993) Histologic aspects of pulmonary baro-traumas in critically ill patients with acute respiratory failure. Intensive Care Med 19: 383389Google Scholar
  6. 6.
    Dreyfuss D, Basset G, Soler P, Saumon G (1985) High inflation pressure pulmonary edema: respective effects of high airway pressure, high tidal volume and positive end-expiratory pressure. Am Rev Respir Dis 137: 1159–1164CrossRefGoogle Scholar
  7. 7.
    Parker CJ, Hernandez LA, Peevy KJ (1993) Mechanisms of ventilator-induced lung injury. Crit Care Med 21: 131–143PubMedCrossRefGoogle Scholar
  8. 8.
    Trembley L, Valenza F, Ribeiro S, et al (1997) Injurious ventilatory strategies increases cytokines and c-fos m-RNA expression in an isolated rat lung model. J Clin Invest 99: 944952Google Scholar
  9. 9.
    Ricard JD, Dreyfuss D, Saumon G (2001) Production of inflammatory cytokines in ventilator-induced lung injury: a reappraisal. Am J Respir Crit Care Med 163: 1176–1180PubMedCrossRefGoogle Scholar
  10. 10.
    Hickling KG, Henderson SJ, Jackson R (1990) Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med 16: 372–377PubMedCrossRefGoogle Scholar
  11. 11.
    Amato MBP, Barbas CSV, Medeiros DM, et al (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338: 347–354PubMedCrossRefGoogle Scholar
  12. 12.
    Brochard L, Roudot-Thorval F, Roupie E, et al (1998) Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. Am J Respir Crit Care Med 158: 1831–1838PubMedCrossRefGoogle Scholar
  13. 13.
    Stewart TE, Meade MO, CooK DJ, et al (1998) Evaluation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. N Engl J Med 338: 355–361PubMedCrossRefGoogle Scholar
  14. 14.
    The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volume tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342: 1301–1308CrossRefGoogle Scholar
  15. 15.
    Brower RG, Shanholtz CB, Fessler HE, et al (1999) Prospective, randomised, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients. Crit Care Med 27: 1492–1498PubMedCrossRefGoogle Scholar
  16. 16.
    Taskar V, John J, Evander E, Robertson B, Jonson B (1997) Surfactant dysfunction makes lung vulnerable to repetitive collapse and re-expansion. Am J Respir Crit Care Med 155: 313–320PubMedCrossRefGoogle Scholar
  17. 17.
    Muscedere JG, Mullen JBM, Gan K, Slutsky AS (1994) Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med 149: 1327–1334PubMedCrossRefGoogle Scholar
  18. 18.
    Mead J, Takishima T, Leith D (1970) Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol 28: 596–608PubMedGoogle Scholar
  19. 19.
    Lachmann B (1992) Open up the lung and keep the lung open. Intensive Care Med 18: 319321Google Scholar
  20. 20.
    International Consensus Conference in intensive care medicine (1999) Ventilator-associated lung injury in ARDS. Am J Respir Crit Care Med 160: 2118–2114CrossRefGoogle Scholar
  21. 21.
    de Durante G, del Turco M, Rustichini L, et al (2002) ARDSNet lower tidal volume ventilatory strategy may generate intrinsic positive end-expiratory pressure in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 165: 1271–1274PubMedCrossRefGoogle Scholar
  22. 22.
    Lapinski SE, Aubin M, Metha S, Boiteau P, Slutsky AS (1999) Safety and efficacy of sustained inflation for alveolar recruitment in adults for respiratory failure. Intensive Care Med 25: 1297–1301CrossRefGoogle Scholar
  23. 23.
    Grasso S, Mascia L, Del Turco M, et al (2002) Effects of recruitment maneuvers in patients with acute respiratory distress syndrome ventilated with protective ventilatory strategy. Anesthesiology 96: 795–802PubMedCrossRefGoogle Scholar
  24. 24.
    Rimensberger PC, Cox PN, Frova H, et al (1999) The open lung during small tidal volume ventilation: concepts of recruitment and optimal PEEP. Crit Care Med 27: 1946–1952PubMedCrossRefGoogle Scholar
  25. 25.
    Van der Kloof TE, Blanch L, Youngblood AM (2000) Recruitment maneuvers in three experimental models of acute lung injury, Am J Respir Crit Care Med 161: 1485–1494CrossRefGoogle Scholar
  26. 26.
    Medoff BD, Harris RS, Kesselman H, et al (2000) Use of recruitment maneuvers and high positive end expiratory pressure in patient with acute respiratory distress syndrome. Crit Care Med 28: 1210–1216PubMedCrossRefGoogle Scholar
  27. 27.
    Pelosi P, Cadringher P, Bottino N, et al (1999) Sigh in acute respiratory distress syndrome. Am J Respir Crit Care Med 159: 872–880PubMedCrossRefGoogle Scholar
  28. 28.
    Foti G, Cereda M, Sparacino ME, De Marchi L, Villa F, Pesenti A (2000) Effects of periodic lung recruitment maneuvers on gas exchange and respiratory mechanics in mechanically ventilated acute respiratory distress syndrome ( ARDS) patients. Intensive Care Med 26: 501–507Google Scholar
  29. 29.
    Patroniti N, Foti G, Cortinovis B, et al (2002) Sigh improves gas exchange and lung volume in patients with acute respiratory distress syndrome undergoing pressure support ventilation. Anesthesiology 96: 788–794PubMedCrossRefGoogle Scholar
  30. 30.
    Bendixen HH, Smith GM, Mead J (1964) Pattern of ventilation in young adults. J Appl Physiol 19: 195–198PubMedGoogle Scholar
  31. 31.
    Mead J, Collier C (1959) Relation of volume history of lungs to respiratory mechanicsin anesthetized dogs. J Appl Physiol 14: 669–678Google Scholar
  32. 32.
    Mcllroy MB, Butler J, Finley TN (1962) Effects of chest compression on reflex ventilatory drive and pulmonary function. J Appl Physiol 17: 701–705Google Scholar
  33. 33.
    Egbert LD, Laver MB, Bendixen HH (1963) Intermittent deep breaths and compliance during anesthesia in man. Anesthesiology 24: 57–60CrossRefGoogle Scholar
  34. 34.
    Housley E, Louzada N, Becklake MR (1970) To sigh or not to sigh. Am Rev Respir Dis 101: 611–614PubMedGoogle Scholar
  35. 35.
    Fairley HB (1976) The mechanical ventilation sigh is a dodo. Respir Care 21: 1127–1130PubMedGoogle Scholar
  36. 36.
    Davies K, Branson RD, Campbell RS, Perembka DT, Johnson DJ (1993) The addition of sighs during pressure support ventilation. Is there a benefit? Chest; 104: 867–870CrossRefGoogle Scholar
  37. 37.
    Pelosi P, Golden A, Mckihbemn A, et al (2001) Recruitment and derecruitment during acute respiratory failure. An experimental study. Am J Respir Crit Care Med 164: 122–130Google Scholar
  38. 38.
    Crotti S, Mascheroni D, Caironi P (2001) Recruitment and derecruitment during acute respirtaory failure. A clinical study. Am J Respir Crit Care Med 164: 131–140Google Scholar
  39. 39.
    Hickling KG (1998) The pressure volume curve is greatly modified by recruitment: a mathematical model of ARDS lungs. Am J Respir Crit Care Med 158: 194–202PubMedCrossRefGoogle Scholar
  40. 40.
    Dambrosio M, Roupie E, Mollet JJ, et al (1997) Effects of positive end-expiratory pressure and different tidal volumes on alveolar recruitment and hyperinflation. Anesthesiology 87: 495–503PubMedCrossRefGoogle Scholar
  41. 41.
    Cereda M, Foti G, Musch G, Sparacino ME, Pesenti A (1996) Positive end-expiratory pressure prevents the loss of respiratory compliance during low tidal volume ventilation in acute lung injury patients. Chest 109: 480–485PubMedCrossRefGoogle Scholar
  42. 42.
    Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G (1995) Re-expansion of atelectasis during general anesthesia: a computed tomography study. Acta Anaesthesiol Scand 39: 118–125PubMedCrossRefGoogle Scholar
  43. 43.
    Richard JC, Maggiore SM, Jonson B, Mancebo J, Lemaire F, Brochard L (2001) Influence of tidal volume on alveolar recruitment: respective role of PEEP and a recruitment maneuver. Am J Respir Crit Care Med 163: 1609–1613PubMedCrossRefGoogle Scholar
  44. 44.
    Putensen C, Rasanen J, Lopez FA (1994) Ventilation-perfusion distributions during mechanical ventilation with superimposed spontaneous breathing in canine lung injury. Am J Respir Crit Care Med 150: 101–108PubMedCrossRefGoogle Scholar
  45. 45.
    Putensen C, Zech S, Wrigge H, et al (2001) Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med 164: 43–49PubMedCrossRefGoogle Scholar
  46. 46.
    Brochard L (1994) Pressure support ventilation. In: Tobin MJ (ed) Principles and Practice of mechanical ventilation, 1st edn. McGraw, NewYork, pp 239–257Google Scholar
  47. 47.
    Cereda M, Foti G, Marcora B, et al (2000) Pressare support ventilation in patients with acute lung injury. Crit Care Med 28: 1269–1275PubMedCrossRefGoogle Scholar
  48. 48.
    Goodman NW, Dow AC (1993) Effect of active and passive sighs in normoxia and hyperxia on the breathing of patients anesthetized with infusion of propofol. Br J Anaesth 70: 536541Google Scholar
  49. 49.
    Pesenti A, Rossi N, Calori A, Foti G, Rossi GP (1993) Effects of short-term oxygenation changes on acute lung injury patients undergoing pressare support ventilation. Chest 103: 1185–1189PubMedCrossRefGoogle Scholar
  50. 50.
    Pelosi P, Chiumello D, Calvi E, et al (2001) Effects of different continuous positive airway pressure devices and periodic hyperinflations on respiratory function. Crit Care Med 29: 1683–1689PubMedCrossRefGoogle Scholar
  51. 51.
    Marini JJ, Amato MB (1998) Lung recruitment during ARDS. In: Marini JJ, Evans TW (eds) Acute Lung Injury. Berlin, Springer, pp 288–295Google Scholar
  52. 52.
    Gaver DP III, Samsel RW, Solway J (1990) Effects of surface tension and viscosity on airway reopening. J Appl Physiol 69: 74–85PubMedGoogle Scholar
  53. 53.
    Day R, Goodfellow AM, Apgar V, et al (1952) Pressure-time relations in the safe correction of atelectasis in animal lungs. Pediatrics 10: 593–602PubMedGoogle Scholar
  54. 54.
    Neumann P, Berglund JE, Mondejar EF, et al (1998) Effect of different pressure levels on the dynamics of lung collapse and recruitment in oleic-acid-induced lung injury. Am J Respir Crit Care Med 158: 1636–1643PubMedCrossRefGoogle Scholar
  55. 55.
    Gattinoni L, Pelosi P, Suter PM, et al (1998) Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease: different syndromes? Am J Respir Crit Care Med 158: 3–11PubMedCrossRefGoogle Scholar
  56. 56.
    Pelosi P, d’Andrea L, Vitale G, et al (1994) Vertical gradient of regional lung inflation in adult respiratory distress syndrome. Am J Respir Crit Care 149: 8–13CrossRefGoogle Scholar
  57. 57.
    Dantzker DR, Wagner PD, West JB (1975) Instability of lung units with low Va/Q ratios during 02 breathing. J Appl Physiol 38: 886–895Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • N. Patroniti
  • G. Foti
  • A. Pesenti

There are no affiliations available

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