About: Tidal Volume Lowering by Instrumental Dead Space Reduction in Brain-Injured ARDS Patients: Effects on Respiratory Mechanics, Gas Exchange, and Cerebral Hemodynamics

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type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
title	Tidal Volume Lowering by Instrumental Dead Space Reduction in Brain-Injured ARDS Patients: Effects on Respiratory Mechanics, Gas Exchange, and Cerebral Hemodynamics
Creator	Antonelli, Massimo D' Arrigo, Sonia Di Giannatale, Pierluigi Eleuteri, Davide Ferrieri, Alessandro Grieco, Domenico Idone, Francesco Jonson, Bjorn Maggiore, Salvatore Natalini, Daniele Pitoni, Sara Santantonio, Maria
source	PMC
abstract	BACKGROUND: Limiting tidal volume (V(T)), plateau pressure, and driving pressure is essential during the acute respiratory distress syndrome (ARDS), but may be challenging when brain injury coexists due to the risk of hypercapnia. Because lowering dead space enhances CO(2) clearance, we conducted a study to determine whether and to what extent replacing heat and moisture exchangers (HME) with heated humidifiers (HH) facilitate safe V(T) lowering in brain-injured patients with ARDS. METHODS: Brain-injured patients (head trauma or spontaneous cerebral hemorrhage with Glasgow Coma Scale at admission < 9) with mild and moderate ARDS received three ventilatory strategies in a sequential order during continuous paralysis: (1) HME with V(T) to obtain a PaCO(2) within 30–35 mmHg (HME1); (2) HH with V(T) titrated to obtain the same PaCO(2) (HH); and (3) HME1 settings resumed (HME2). Arterial blood gases, static and quasi-static respiratory mechanics, alveolar recruitment by multiple pressure–volume curves, intracranial pressure, cerebral perfusion pressure, mean arterial pressure, and mean flow velocity in the middle cerebral artery by transcranial Doppler were recorded. Dead space was measured and partitioned by volumetric capnography. RESULTS: Eighteen brain-injured patients were studied: 7 (39%) had mild and 11 (61%) had moderate ARDS. At inclusion, median [interquartile range] PaO(2)/FiO(2) was 173 [146–213] and median PEEP was 8 cmH(2)O [5–9]. HH allowed to reduce V(T) by 120 ml [95% CI: 98–144], V(T)/kg predicted body weight by 1.8 ml/kg [95% CI: 1.5–2.1], plateau pressure and driving pressure by 3.7 cmH(2)O [2.9–4.3], without affecting PaCO(2), alveolar recruitment, and oxygenation. This was permitted by lower airway (− 84 ml [95% CI: − 79 to − 89]) and total dead space (− 86 ml [95% CI: − 73 to − 98]). Sixteen patients (89%) showed driving pressure equal or lower than 14 cmH(2)O while on HH, as compared to 7 (39%) and 8 (44%) during HME1 and HME2 (p < 0.001). No changes in mean arterial pressure, cerebral perfusion pressure, intracranial pressure, and middle cerebral artery mean flow velocity were documented during HH. CONCLUSION: The dead space reduction provided by HH allows to safely reduce V(T) without modifying PaCO(2) nor cerebral perfusion. This permits to provide a wider proportion of brain-injured ARDS patients with less injurious ventilation.
has issue date	2020-04-22(xsd:dateTime)
bibo:doi	10.1007/s12028-020-00969-5
bibo:pmid	32323146
has license	no-cc
sha1sum (hex)	32a91051a7ea7822cc3100e9ee3e8869bea7de38
schema:url	https://doi.org/10.1007/s12028-020-00969-5
resource representing a document's title	Tidal Volume Lowering by Instrumental Dead Space Reduction in Brain-Injured ARDS Patients: Effects on Respiratory Mechanics, Gas Exchange, and Cerebral Hemodynamics
has PubMed Central identifier	PMC7224122
has PubMed identifier	32323146
schema:publication	Neurocrit Care
resource representing a document's body	covid:32a91051a7ea7822cc3100e9ee3e8869bea7de38#body_text
is schema:about of	named entity 'Reduction' named entity 'PLATEAU PRESSURE' named entity 'determine' named entity 'Tidal Volume' named entity 'respiratory rate' named entity 'ARDS' named entity 'brain-injured' named entity 'venous return' named entity 'Declaration of Helsinki' named entity 'PEEP' named entity 'dead space' named entity 'alveolar' named entity 'PEEP' named entity 'critically ill patients' named entity 'attending physician' named entity 'respiratory rates' named entity 'continuous infusion' named entity 'blood flow velocity' named entity 'respiratory mechanics' named entity 'hypoxemia' named entity 'end tidal' named entity 'tidal volume' named entity 'sedation' named entity 'dead space' named entity 'heart rate' named entity 'Fisher & Paykel' named entity 'ARDS' named entity 'adverse events' named entity 'arterial pressure' named entity 'dead space' named entity 'capnograph' named entity 'brain injury' named entity 'cerebral perfusion pressure' named entity 'standard of care' named entity 'dead space' named entity 'physiological dead space' named entity 'brain injury' named entity 'ARDS' named entity 'brain injury' named entity 'hypercapnia' named entity 'tidal volume' named entity 'contraindication' named entity 'hemodynamics' named entity 'brain-injured' named entity 'ARDS' named entity 'brain-injured' named entity 'PEEP' named entity 'brain-injured' named entity 'physiological' named entity 'flow velocity' named entity 'cerebral perfusion pressure' named entity 'Elema' named entity 'ARDS' named entity 'elastance' named entity 'arterial blood pressure' named entity 'cisatracurium' named entity 'intracranial pressure' named entity 'dead space' named entity 'PEEP' named entity 'PEEP' named entity 'syringe' named entity 'muscle paralysis' named entity 'gas mixture' named entity 'dead space' named entity 'cardiac output' named entity 'cisatracurium' named entity 'cerebral hemorrhage' named entity 'inflection point' named entity 'central venous pressure' named entity 'inflection point'

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