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[The open lung concept. Clinical application in severe thoracic trauma]
D Schreiter1, A Reske, L Scheibner
1Chirurgische ITS, Zentrum für Chirurgie, Universität Leipzig, Liebigstrasse 20a, 04103 Leipzig. dschr@medizin.uni-leipzig.de
Summary
The Open Lung Concept (OLC) effectively treats hypoxia from pulmonary contusion by recruiting lung areas. This lung-protective ventilation strategy improves oxygenation with minimal tidal volumes, maintaining normocapnia without perfusion impairment.
Area of Science:
- Critical Care Medicine
- Pulmonary Medicine
- Trauma Surgery
Background:
- Pulmonary contusion causes parenchymal hemorrhage, edema, and surfactant system damage.
- This leads to ventilation-perfusion imbalance and hypoxia.
- Severe chest contusion is a significant complication in polytraumatized patients.
Purpose of the Study:
- To evaluate the effectiveness of the Open Lung Concept (OLC) in treating severe chest contusion in polytraumatized patients.
- To assess the impact of OLC on oxygenation and ventilation parameters.
- To determine if OLC facilitates lung-protective ventilation strategies.
Main Methods:
- 32 polytraumatized patients with severe chest contusion were ventilated using the OLC.
- OLC involves recruiting atelectatic lung areas with positive inspiratory pressure (PIP) and maintaining them with PEEP.
- Initial oxygenation was assessed by the paO2/FIO2 ratio.
Main Results:
- A mean PIP of 65 mbar and total-PEEP of 22 mbar were used for recruitment.
- The paO2/FIO2 ratio significantly improved from 134 to 522 mmHg (P < 0.001).
- Lung-protective ventilation with minimal tidal volumes (3.5 ml/kg) maintained oxygenation and normocapnia without adverse effects.
Conclusions:
- OLC is a highly effective treatment for ventilation-perfusion impairment in pulmonary contusion.
- The method allows for lung-protective ventilation with minimal tidal volumes and reduced PIP.
- OLC appears to be a safe and beneficial approach for managing severe chest trauma.