Pressure support ventilation and biphasic positive airway pressure improve oxygenation by redistribution of pulmonary blood flow

Detalhes bibliográficos
Autor(a) principal: Carvalho, Alysson R.
Data de Publicação: 2009
Outros Autores: Spieth, Peter M., Pelosi, Paolo, Beda, Alessandro, Lopes, Agnaldo J., Neykova, Boriana, Heller, Axel R., Koch, Thea, Abreu, Marcelo Gama de
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/38768
Resumo: Alysson R. Carvalho. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.
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spelling Carvalho, Alysson R.Spieth, Peter M.Pelosi, PaoloBeda, AlessandroLopes, Agnaldo J.Neykova, BorianaHeller, Axel R.Koch, TheaAbreu, Marcelo Gama de2019-12-20T13:37:54Z2019-12-20T13:37:54Z2009CARVALHO, Alysson R. et al. Pressure support ventilation and biphasic positive airway pressure improve oxygenation by redistribution of pulmonary blood flow. Anesthesia & Analgesia, v. 109, n. 3, p. 856-865, Sept. 2009.0003-2999https://www.arca.fiocruz.br/handle/icict/3876810.1213/ane.0b013e3181aff2451526-7598Alysson R. Carvalho. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.2020-12-20University Augusto Motta. Rio de Janeiro, RJ, Brazil.University Clinic Carl Gustav Carus. Clinic of Anesthesiology and Intensive Care Medicine. Dresden, Germany.University of Insubria. Department of Ambient, Health and Safety. Varese, Italy.University Clinic Carl Gustav Carus. Clinic of Anesthesiology and Intensive Care Medicine. Dresden, Germany.University Augusto Motta. Rio de Janeiro, RJ, Brazil.Technical University Dresden. University Clinic Carl Gustav Carus. Institute of Radiology. Dresden, Germany.University Clinic Carl Gustav Carus. Clinic of Anesthesiology and Intensive Care Medicine. Dresden, Germany.University Clinic Carl Gustav Carus. Clinic of Anesthesiology and Intensive Care Medicine. Dresden, Germany.University Clinic Carl Gustav Carus. Clinic of Anesthesiology and Intensive Care Medicine. Dresden, Germany.BACKGROUND: Spontaneous breathing (SB) activity may improve gas exchange during mechanical ventilation mainly by the recruitment of previously collapsed regions. Pressure support ventilation (PSV) and biphasic positive airway pressure (BIPAP) are frequently used modes of SB, but little is known about the mechanisms of improvement of lung function during these modes of assisted mechanical ventilation. We evaluated the mechanisms behind the improvement of gas exchange with PSV and BIPAP. METHODS: Five pigs (25–29.3 kg) were mechanically ventilated in supine position, and acute lung injury (ALI) was induced by surfactant depletion. After stabilization, BIPAP was initiated with lower continuous positive airway pressure equal to 5 cm H2O and the higher continuous positive airway pressure titrated to achieve a tidal volume between 6 and 8 mL/kg. The depth of anesthesia was reduced, and when SB represented ≥ 20% of total minute ventilation, PSV and BIPAP + SB were each performed for 1 h (random sequence). Whole chest helical computed tomography was performed during end-expiratory pauses and functional variables were obtained. Pulmonary blood flow (PBF) was marked with IV administered fluorescent microspheres, and spatial cluster analysis was used to determine the effects of each ventilatory mode on the distribution of PBF. RESULTS: ALI led to impairment of lung function and increase of poorly and nonaerated areas in dependent lung regions (P < 0.05). PSV and BIPAP + SB similarly improved oxygenation and reduced venous admixture compared with controlled mechanical ventilation (P < 0.05). Despite that, a significant increase of nonaerated areas in dependent regions with a concomitant decrease of normally aerated areas was observed during SB. In five of six lung clusters, redistribution of PBF from dependent to nondependent, better aerated lung regions were observed during PSV and BIPAP + SB. CONCLUSIONS: In this model of ALI, the improvements of oxygenation and venous admixture obtained during assisted mechanical ventilation with PSV and BIPAP + SB were explained by the redistribution of PBF toward nondependent lung regions rather than recruitment of dependent zones.engLippincott, Williams & WilkinsPressure support ventilation and biphasic positive airway pressure improve oxygenation by redistribution of pulmonary blood flowinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlePressure support ventilationBiphasic positive airway pressurePulmonary blood flowLung functioninfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txttext/plain1748https://www.arca.fiocruz.br/bitstream/icict/38768/1/license.txt8a4605be74aa9ea9d79846c1fba20a33MD51ORIGINALve_Carvalho_Alysson_etal_INI_2009.pdfve_Carvalho_Alysson_etal_INI_2009.pdfapplication/pdf734839https://www.arca.fiocruz.br/bitstream/icict/38768/2/ve_Carvalho_Alysson_etal_INI_2009.pdf76567ad92554b06616227db07794a13dMD52TEXTve_Carvalho_Alysson_etal_INI_2009.pdf.txtve_Carvalho_Alysson_etal_INI_2009.pdf.txtExtracted texttext/plain49961https://www.arca.fiocruz.br/bitstream/icict/38768/3/ve_Carvalho_Alysson_etal_INI_2009.pdf.txtad7ac34f5a3b5b82d698a06f76e01021MD53icict/387682021-03-24 16:32:40.808oai:www.arca.fiocruz.br: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Repositório InstitucionalPUBhttps://www.arca.fiocruz.br/oai/requestrepositorio.arca@fiocruz.bropendoar:21352021-03-24T19:32:40Repositório Institucional da FIOCRUZ (ARCA) - Fundação Oswaldo Cruz (FIOCRUZ)false
dc.title.pt_BR.fl_str_mv Pressure support ventilation and biphasic positive airway pressure improve oxygenation by redistribution of pulmonary blood flow
title Pressure support ventilation and biphasic positive airway pressure improve oxygenation by redistribution of pulmonary blood flow
spellingShingle Pressure support ventilation and biphasic positive airway pressure improve oxygenation by redistribution of pulmonary blood flow
Carvalho, Alysson R.
Pressure support ventilation
Biphasic positive airway pressure
Pulmonary blood flow
Lung function
title_short Pressure support ventilation and biphasic positive airway pressure improve oxygenation by redistribution of pulmonary blood flow
title_full Pressure support ventilation and biphasic positive airway pressure improve oxygenation by redistribution of pulmonary blood flow
title_fullStr Pressure support ventilation and biphasic positive airway pressure improve oxygenation by redistribution of pulmonary blood flow
title_full_unstemmed Pressure support ventilation and biphasic positive airway pressure improve oxygenation by redistribution of pulmonary blood flow
title_sort Pressure support ventilation and biphasic positive airway pressure improve oxygenation by redistribution of pulmonary blood flow
author Carvalho, Alysson R.
author_facet Carvalho, Alysson R.
Spieth, Peter M.
Pelosi, Paolo
Beda, Alessandro
Lopes, Agnaldo J.
Neykova, Boriana
Heller, Axel R.
Koch, Thea
Abreu, Marcelo Gama de
author_role author
author2 Spieth, Peter M.
Pelosi, Paolo
Beda, Alessandro
Lopes, Agnaldo J.
Neykova, Boriana
Heller, Axel R.
Koch, Thea
Abreu, Marcelo Gama de
author2_role author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Carvalho, Alysson R.
Spieth, Peter M.
Pelosi, Paolo
Beda, Alessandro
Lopes, Agnaldo J.
Neykova, Boriana
Heller, Axel R.
Koch, Thea
Abreu, Marcelo Gama de
dc.subject.en.pt_BR.fl_str_mv Pressure support ventilation
Biphasic positive airway pressure
Pulmonary blood flow
Lung function
topic Pressure support ventilation
Biphasic positive airway pressure
Pulmonary blood flow
Lung function
description Alysson R. Carvalho. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.
publishDate 2009
dc.date.issued.fl_str_mv 2009
dc.date.accessioned.fl_str_mv 2019-12-20T13:37:54Z
dc.date.available.fl_str_mv 2019-12-20T13:37:54Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.citation.fl_str_mv CARVALHO, Alysson R. et al. Pressure support ventilation and biphasic positive airway pressure improve oxygenation by redistribution of pulmonary blood flow. Anesthesia & Analgesia, v. 109, n. 3, p. 856-865, Sept. 2009.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/38768
dc.identifier.issn.pt_BR.fl_str_mv 0003-2999
dc.identifier.doi.none.fl_str_mv 10.1213/ane.0b013e3181aff245
dc.identifier.eissn.none.fl_str_mv 1526-7598
identifier_str_mv CARVALHO, Alysson R. et al. Pressure support ventilation and biphasic positive airway pressure improve oxygenation by redistribution of pulmonary blood flow. Anesthesia & Analgesia, v. 109, n. 3, p. 856-865, Sept. 2009.
0003-2999
10.1213/ane.0b013e3181aff245
1526-7598
url https://www.arca.fiocruz.br/handle/icict/38768
dc.language.iso.fl_str_mv eng
language eng
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Lippincott, Williams & Wilkins
publisher.none.fl_str_mv Lippincott, Williams & Wilkins
dc.source.none.fl_str_mv reponame:Repositório Institucional da FIOCRUZ (ARCA)
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