Advertisement

Respiratory mechanics in ARDS

  • P. Pelosi
  • M. Resta
  • L. Gattinoni
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)

Abstract

Diagnostic and prognostic value of the assessment of respiratory mechanics in patients with adult respiratory distress syndrome (ARDS) has been extensively investigated and clearly defined [1–3]. Most studies have investigated the role of compliance and resistance of the total respiratory system in ARDS patients, but only few studies separately considered the relative contributions of the lung and the chest wall. Partitioning of the respiratory mechanics into its lung and chest wall components, in fact, needs the use of an esophageal balloon which is considered, by the majority of physicians, a waste of time and a tedious technique. However, it may allow better definition of the pathophysiology of ARDS in order to improve the consequent clinical management.

Keywords

Lung Volume Acute Respiratory Failure Respir Crit Functional Residual Capacity Adult Respiratory Distress Syndrome 
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.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bone RC (1976) Diagnosis of causes for acute respiratory distress by pressure-volume curves. Chest 70:740–746PubMedCrossRefGoogle Scholar
  2. 2.
    Mancebo J, Benito S, Net A (1988) Value of static pulmonary compliance in predicting mortality in patients with acute respiratory failure. Intensive Care Med 14:110–114PubMedCrossRefGoogle Scholar
  3. 3.
    Gattinoni L, Pesenti A, Caspani ML et al (1984) The role of static lung compliance in the management of severe ARDS unresponsive to conventional treatment. Intensive Care Med 10:121–126PubMedCrossRefGoogle Scholar
  4. 4.
    Polese G, Rossi A, Appendini L, Brandi G, Bates JHT, Brandolese R (1991) Partitioning of respiratory mechanics in mechanically ventilated patients. J Appl Physiol 71:2425–2433PubMedGoogle Scholar
  5. 5.
    Eissa NT, Ranieri VM, Corbeil C et al (1991) Analysis of behavior of the respiratory system in ARDS patients: effects of flow, volume, and time. J Appl Physiol 70:2719–2729PubMedCrossRefGoogle Scholar
  6. 6.
    Eissa NT, Ranieri VM, Corbeil C, Chassé M, Braidy J, Milic-Emily J (1991) Effects of positive end-expiratory pressure, lung volume and inspiratory flow on interrupter resistance in patients with adult respiratory distress syndrome. Am Rev Respir Dis 144:538–543PubMedCrossRefGoogle Scholar
  7. 7.
    Tantucci C, Corbeil C, Chassé M et al (1992) Flow and volume dependence of respiratory system flow resistance in patient with adult respiratory distress syndrome. Am Rev Respir Dis 145:355–360PubMedGoogle Scholar
  8. 8.
    Brandolese R, Broseghini C, Polese G et al (1993) Effects of intrinsic PEEP on pulmonary gas exchange in mechanically ventilated patients. Eur Respir J 6:358–363PubMedGoogle Scholar
  9. 9.
    Pesenti A, Pelosi P, Rossi N, Aprigliano M, Brazzi L, Fumagalli R (1993) Respiratory mechanics and broncodilatory responsiveness in patients with the adult respiratory distress syndrome. Crit Care Med 21:78–83PubMedCrossRefGoogle Scholar
  10. 10.
    Ranieri VM, Eissa NT, Corbeil C et al (1991) Effects of positive end-expiratory pressure on alveolar recruitment and gas exchange in patients with the adult respiratory distress syndrome. Am Rev Respir Dis 144:544–551PubMedCrossRefGoogle Scholar
  11. 11.
    Matamis D, Lemaire F, Harf A, Brun-Guisson C, Ansquer JC, Atlan G (1984) Total respiratory pressure-volume curves in adult respiratory distress syndrome. Chest 86:58–66PubMedCrossRefGoogle Scholar
  12. 12.
    Jardin F, Genevray B, Brun-Ney D, Bourdarias JP (1985) Influence of lung and chest wall compliances on transmission of airway pressure to the pleural space in critically ill patients. Chest 88:653–658PubMedCrossRefGoogle Scholar
  13. 13.
    Benito S, Lemaire F (1990) Pulmonary pressure-volume relationship in acute respiratory distress syndrome in adults: role of positive end expiratory pressure. J Crit Care 5:27–34CrossRefGoogle Scholar
  14. 14.
    Auler JOC, Salvida PHN, Martins MA et al (1990) Flow and volume dependence of respiratory system mechanics during constant flow ventilation in normal subjects and in adult respiratory distress syndrome. Crit Care Med 18:1080–1086PubMedCrossRefGoogle Scholar
  15. 15.
    Pelosi P, Cereda M, Foti G, Giacomini M, Pesenti A (1995) Alterations of lung and chest wall mechanics in patients with acute lung injury: effects of positive end-expiratory pressure. Am J Respir Crit Care Med 152:531–537PubMedGoogle Scholar
  16. 16.
    Suter IM, Fairley HB, Isenberg MD (1978) Effect of tidal volume and positive end-expiratory pressure on compliance during mechanical ventilation. Chest 73:158–162PubMedCrossRefGoogle Scholar
  17. 17.
    Katz JA, Ozanne GM, Zinn SE, Fairley HB (1981) Time course and mechanisms of lung-volume increase with PEEP in acute pulmonary failure. Anesthesiology 54:9–16PubMedCrossRefGoogle Scholar
  18. 18.
    Benito S, Lemaire F, Mankikian B, Harf A (1985) Total respiratory compliance as a function of lung volume in patients with mechanical ventilation. Intensive Care Med 11:76–79PubMedGoogle Scholar
  19. 19.
    Suter PM, Fairley HB, Schlobohm RM (1975) Shunt, lung volume and perfusion during short periods of ventilation with oxygen. Anesthesiology 43:617–627PubMedCrossRefGoogle Scholar
  20. 20.
    Mancebo J, Calaf N, Benito S (1985) Pulmonary compliance measurement in acute respiratory failure. Critical Care Med 13:589–591CrossRefGoogle Scholar
  21. 21.
    Wrigh PE, Bernard GR (1989) The role of airflow resistance in patients with the adult respiratory distress syndrome. Am Rev Respir Dis 139:1169–1174Google Scholar
  22. 22.
    Mancebo J, Benito S, Calaf N, Net A (1988) Simplified syringe procedures for the estimation of functional residual capacity. J Crit Care 3:180–189CrossRefGoogle Scholar
  23. 23.
    Gattinoni L, Pesenti A, Avalli L, Rossi F, Bombino M (1987) Pressure-volume curve of total respiratory system in acute respiratory failure. Computed tomographic scan study. Am Rev Respir Dis 136:730–736PubMedCrossRefGoogle Scholar
  24. 24.
    Gattinoni L, Bombino M, Pelosi P et al (1994) Lung structure and function in different stages of severe adult respiratory distress syndrome. JAMA 271:1772–1779PubMedCrossRefGoogle Scholar
  25. 25.
    Ranieri VM, Brienza N, Santostasi S et al (1997) Impairment of lung and chest wall mechanics in patients with ARDS. Am J Respir Crit Care Med 156:1082–1091PubMedGoogle Scholar
  26. 26.
    D’Angelo E, Calderini E, Torri G, Robatto F, Bono D, Milic-Emili J (1988) Respiratory mechanics in anesthetized paralyzed humans: Effect of flow, volume and time. J Appl Physiol 64:441–450Google Scholar
  27. 27.
    D’Angelo E, Robatto FM, Calderini E et al (1991) Pulmonary and chest wall mechanics in anesthetized paralyzed humans. J Appl Physiol 70:2602–2610PubMedGoogle Scholar
  28. 28.
    Gattinoni L, D’Andrea L, Pelosi P, Vitale G, Pesenti A, Fumagalli R (1993) Regional effects and mechanism of positive end-expiratory pressure in early adult respiratory distress syndrome. JAMA 269:2122–2127PubMedCrossRefGoogle Scholar
  29. 29.
    Bates JHT, Rossi A, Milic-Emili J (1985) Analysis of the behavior of the respiratory system with constant inspiratory flow. J Appl Physiol 58:1840–1848PubMedGoogle Scholar
  30. 30.
    Pelosi P, D’Andrea L, Vitale G, Pesenti A, Gattinoni L (1994) Vertical gradient of regional inflation in adult respiratory distress syndrome. Am J Respir Grit Care Med 149:8–13Google Scholar
  31. 31.
    Mutoh T, Lamm WJE, Hidebrandt J, Albert RK (1991) Abdominal distention alters regional pleural pressures and chest wall mechanics in pigs in vivo. J Appl Physiol 70:2611–2618PubMedGoogle Scholar
  32. 32.
    Morina P, Herrera M, Venegas J, Mora D, Rodriguez M, Pino E (1997) Effects of nebulized salbutamol on respiratory mechanics in ARDS. Intensive Care Med 23:58–64PubMedCrossRefGoogle Scholar
  33. 33.
    Servillo G, Svantesson G, Beydon L et al (1997) Pressure-volume curves in acute respiratory failure. Am J Respir Grit Care Med 155:1629–1636Google Scholar
  34. 34.
    Mergoni M, Martelli A, Volpi A, Primavera S, Zuccoli P, Rossi A (1997) Impact of positive end-expiratory pressure on chest wall and lung pressure-volume curve in acute respiratory failure. Am J Respir Grit Care Med 156:846–854Google Scholar
  35. 35.
    Pelosi P, Tubiolo D, Mascheroni D et al (1998) Effects of the prone position on respiratory mechanics and gas exchange during acute lung injury. Am J Respir Grit Care Med 157:387–393Google Scholar
  36. 36.
    Blanch L, Mancebo J, Perez M (1997) Short term effects of prone position in critically ill patients with acute respiratory distress syndrome. Intensive Care Med 23:1033–1039PubMedCrossRefGoogle Scholar
  37. 37.
    Gattinoni L, Pelosi P, Suter OM, Pedoto A, Vercesi P, Lissoni A (1998) Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Grit Care Med (in press)Google Scholar
  38. 38.
    Rossi A, Gottfried SB, Zocchi L et al (1985) Measurement of static compliance of total respiratory system in patients with acute respiratory failure during mechanical ventilation. Am Rev Respir Dis 131:672–677PubMedGoogle Scholar
  39. 39.
    Bernasconi M, Ploysongsang Y, Gottfried SB, Milic-Emili J, Rossi A (1988) Respiratory compliance and resistance in mechanically ventilated patients with acute respiratory failure. Intensive Care Medicine 14:547–553PubMedCrossRefGoogle Scholar
  40. 40.
    Broseghini G, Brandolese R, Poggi R et al (1988) Respiratory mechanics during the first day of mechanical ventilation in patients with pulmonary edema and chronic airway obstruction. Am Rev Respir Dis 138:355–361PubMedGoogle Scholar
  41. 41.
    Pesenti A, Pelosi P, Rossi N, Virtuani A, Brazzi L, Rossi A (1991) The effects of positive end-expiratory pressure on respiratory resistance in patients with the adult respiratory distress syndrome and in normal anesthetized subjects. Am Rev Respir Dis 144:101–107PubMedCrossRefGoogle Scholar
  42. 42.
    Katz JA, Zinn SE, Ozanne GM, Fairley HB (1981) Pulmonary, chest wall, and lung-thorax elastances in acute respiratory failure. Chest 80:304–311PubMedCrossRefGoogle Scholar
  43. 43.
    Connors AF, McCaffree DR, Gray BA (1991) Effect of inspiratory flow rate on gas exchange during mechanical ventilation. Am Rev Respir Dis 124:537–543Google Scholar
  44. 44.
    Gottfried SB, Rossi A, Higgs BD et al (1985) Noninvasive determination of respiratory system mechanics during mechanical ventilation for acute respiratory failure. Am Rev Respir Dis 131:414–420PubMedGoogle Scholar
  45. 45.
    Gattinoni L, Mascheroni D, Basilico E, Foti G, Pesenti A, Avalli L (1987) Volume/pressure curve of total respiratory system in paralyzed patients: Artifacts and correction factors. Intensive Care Med 13:19–25PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 1999

Authors and Affiliations

  • P. Pelosi
  • M. Resta
  • L. Gattinoni

There are no affiliations available

Personalised recommendations