Expiratory washout versus optimization of mechanical ventilation during permissive hypercapnia in patients with severe acute respiratory distress syndrome

• Autor(a) principal: Richecoeur, Jack
• Data de Publicação: 2022
• Outros Autores: Lu, Qin, R.R. Vieira, Silvia, Puybasset, Louis, Kalfon, Pierre, Coriat, Pierre, Rouby, Jean-Jaques
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Clinical and Biomedical Research
• Texto Completo: https://seer.ufrgs.br/index.php/hcpa/article/view/125243
• topic: Lesão pulmonar aguda; síndrome da angústia respiratória aguda; ventilação mecânica; insuflação traqueal de gases; lavagem pan-expiratória; Acute lung injury; severe acute distress syndrome; mechanical ventilation; tracheal gas insufflation; expiratory washout

OBJECTIVE: The aim of the present study was to compare three ventilatory techniques for reducing PaCO2in patients with severe acute distress syndrome treated with permissive hypercapnia.MATERIALS AND METHODS: In a group of six patients with severe acute distress syndrome who developed permissive hypercapnia with protective techniques ofmechanical ventilation, three ventilatory strategies were compared: expiratory washout alone, optimized mechanical ventilation, defined as an increase in respiratory frequency associated with a reduction of the instrumental dead space, and the combination of both methods. In all strategies, inspiratory plateau airway pressure was kept constant by setting the extrinsic positive end-expiratory pressure.RESULTS: Expiratory washout and optimized mechanical ventilation had similar effects on CO2 elimination. A further decrease in PaCO2 was observed when bothmethods were combined. Extrinsic positive end-expiratory pressure had to be reduced during expiratory washout, whereas it remained unchanged during optimized mechanical ventilation alone.CONCLUSIONS: In patients with severe acute distress syndrome, who need lower plateau airway pressures in order to avoid overdistention, therefore developinghypercapnia, the increasing respiratory rate and reducing instrumental dead space are as efficient as expiratory washout to reduce PaCO2 and, when used incombination, both techniques have additive effects and result in PaCO2 levels close to normal values.