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[Clinical results with the "open lung concept"]
1Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Charité, Humboldt-Universität zu Berlin Campus Charité Mitte. helmar.wauer@charite.de
Anaesthesiologie Und Reanimation
|May 22, 2003
Summary
The open lung concept, using recruitment maneuvers and PEEP, significantly improved oxygenation in acute lung injury patients. However, side effects like pneumothorax and elevated liver enzymes sometimes limited high PEEP use.
Area of Science:
- Critical Care Medicine
- Pulmonary Medicine
- Mechanical Ventilation
Background:
- The "open lung concept" is increasingly integrated into clinical ventilation strategies.
- While experimental data is promising, clinical application studies of the complete concept are limited.
- This study aimed to assess the clinical applicability of the open lung concept.
Purpose of the Study:
- To evaluate the clinical applicability of the open lung concept with recruitment maneuvers and titrated PEEP.
- To determine if significant improvements in oxygenation could be achieved.
- To identify and examine potential side effects of this ventilatory strategy.
Main Methods:
- Twenty consecutive patients with acute lung injury (ALI) received a recruitment maneuver (RM).
- Positive End-Expiratory Pressure (PEEP) was titrated to maintain lung inflation.
- Patients were managed with pressure-controlled ventilation.
Main Results:
- The oxygenation index (P/F-Ratio) significantly improved from 137 +/- 41 to 381 +/- 150 torr (p < 0.001).
- The average titrated PEEP required to keep the lung open was 17 +/- 3 cmH2O.
- One patient developed pneumothorax; ten required increased norepinephrine; three needed PEEP reduction due to elevated liver enzymes.
Conclusions:
- Clinical application of the open lung concept rapidly and effectively improved oxygenation in ALI patients.
- The strategy's effectiveness was sometimes limited by side effects, necessitating adjustments to PEEP levels.