American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Jun 2024
Limiting Overdistention or Collapse when Mechanically Ventilating Injured Lungs: A Randomized Study in a Porcine Model.
Rationale: It is unknown whether preventing overdistention or collapse is more important when titrating positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome (ARDS). Objectives: To compare PEEP targeting minimal overdistention or minimal collapse or using a compromise between collapse and overdistention in a randomized trial and to assess the impact on respiratory mechanics, gas exchange, inflammation, and hemodynamics. Methods: In a porcine model of ARDS, lung collapse and overdistention were estimated using electrical impedance tomography during a decremental PEEP titration. ⋯ Inflammatory markers were not significantly different. Conclusions: PEEP to minimize overdistention resulted in high mortality in an animal model of ARDS. Minimizing collapse or choosing a compromise between collapse and overdistention may result in less lung injury, with potential benefits of the compromise approach.
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Am. J. Respir. Crit. Care Med. · Jun 2024
Editorial Comment LetterAlveolar Collapse as a Threat to Mechanically Ventilated Lungs.