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2017, Number 1

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Med Crit 2017; 31 (1)

Utility of lung ultrasound for PEEP titration in patients with acute respiratory distress syndrome with Berlin classification moderate and severe

Torres AO, Rodríguez PG, Castillejos SH, Monares CE, Aguirre SJ, Franco GJ

Language: Spanish
References: 47
Page: 7-15
PDF size: 223.96 Kb.


ABSTRACT

Mechanical ventilation is a cornerstone in the management of acute respiratory distress syndrome (ARDS). PEEP is a strategy that improves the patient’s outcome. Lung ultrasound is now a main tool in the intensive care unit; therefore, it could have a role in the titration of PEEP. We conducted a prospective study in 20 patients with ARDS, and titrated PEEP with lung ultrasound at the bedside.
Objectives: Primary objective: Assessing the usefulness of lung ultrasound for PEEP titration in ARDS. Secondary objective: To compare four methods of PEEP titration with lung ultrasound findings.
Material and methods: Prospective and observation study. Inclusion criteria: Patients with moderate and severe ARDS according to the Berlin classification, 18 years and older.
Results: Twenty patients (p), 11 males (55%), nine females (45%); 16 (80%) with PaO2/FiO2 ≤ 150 mmHg and four (20%) with PaO2/FiO2 › 150 mmHg. BNP in 19 p (95%); 11 of them (57%) ≤ 250 ng/dL and nine (42.2%) › 250 ng/dL. In 17 p (85%), a recruitment potential was observed, represented by an increase of compliance by 1 mL/cmH2O or decrease of 1% in death space. Using slow-flow curve, the mean lower inflection point was 7.2 cmH2O, the upper inflection point was 21.9 cmH2O, and the middle was 13.5 cmH2O; the lower volume, 105.1 mL, the higher volume, 428.7 mL. The best compliance method was also performed on 19 of these patients (95%); then, PEEP was titrated in 16 cmH2O in 5p (26%), 14 cmH2O (15.7%), 12 cmH2O (21%), 10 cmH2O (15.7%) and 8 cmH2O (26.3%). Lung ultrasound could be performed in 14 patients (70%).
Conclusions: It is feasible to perform a lung ultrasound at the patient’s bedside. It may be useful in the titration of PEEP, without risks for the patient. It may be another tool for the prevention of lung overdistension..


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