Effects of positive end-expiratory pressure on gas exchange and expiratory flow limitation in adult respiratory distress syndrome*

2002 ◽  
Vol 30 (9) ◽  
pp. 1941-1949 ◽  
Author(s):  
Antonia Koutsoukou ◽  
Basilis Bekos ◽  
Christina Sotiropoulou ◽  
Nickolaos G. Koulouris ◽  
Charis Roussos ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Adult Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Flow Limitation ◽  
Positive End Expiratory Pressure ◽  
Expiratory Flow Limitation ◽  
Expiratory Flow

Static pressure-volume curves and effect of positive end-expiratory pressure on gas exchange in adult respiratory distress syndrome

1983 ◽  
Vol 11 (8) ◽  
pp. 591-597 ◽  
Author(s):  
LAURENT HOLZAPFEL ◽  
DOMINIQUE ROBERT ◽  
FRANCOIS PERRIN ◽  
PIERRE LOUIS BLANC ◽  
BRUNO PALMIER ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Adult Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Static Pressure ◽  
Positive End Expiratory Pressure

scholarly journals Airway Closure and Expiratory Flow Limitation in Acute Respiratory Distress Syndrome

2022 ◽  
Vol 12 ◽  
Author(s):  
Claude Guérin ◽  
Martin Cour ◽  
Laurent Argaud
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Flow Limitation ◽  
Airway Closure ◽  
Opening Pressure ◽  
Expiratory Flow Limitation ◽  
Airway Opening ◽  
Expiratory Flow

Acute respiratory distress syndrome (ARDS) is mostly characterized by the loss of aerated lung volume associated with an increase in lung tissue and intense and complex lung inflammation. ARDS has long been associated with the histological pattern of diffuse alveolar damage (DAD). However, DAD is not the unique pathological figure in ARDS and it can also be observed in settings other than ARDS. In the coronavirus disease 2019 (COVID-19) related ARDS, the impairment of lung microvasculature has been pointed out. The airways, and of notice the small peripheral airways, may contribute to the loss of aeration observed in ARDS. High-resolution lung imaging techniques found that in specific experimental conditions small airway closure was a reality. Furthermore, low-volume ventilator-induced lung injury, also called as atelectrauma, should involve the airways. Atelectrauma is one of the basic tenet subtending the use of positive end-expiratory pressure (PEEP) set at the ventilator in ARDS. Recent data revisited the role of airways in humans with ARDS and provided findings consistent with the expiratory flow limitation and airway closure in a substantial number of patients with ARDS. We discussed the pattern of airway opening pressure disclosed in the inspiratory volume-pressure curves in COVID-19 and in non-COVID-19 related ARDS. In addition, we discussed the functional interplay between airway opening pressure and expiratory flow limitation displayed in the flow-volume curves. We discussed the individualization of the PEEP setting based on these findings.

Lung and chest wall mechanics in patients with acute respiratory distress syndrome, expiratory flow limitation, and airway closure

2020 ◽  
Vol 128 (6) ◽  
pp. 1594-1603 ◽  
Author(s):  
Claude Guérin ◽  
Nicolas Terzi ◽  
Louis-Marie Galerneau ◽  
Mehdi Mezidi ◽  
Hodane Yonis ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Distress Syndrome ◽  
Flow Limitation ◽  
Airway Closure ◽  
Positive End Expiratory Pressure ◽  
Expiratory Flow Limitation ◽  
Lung Elastance ◽  
Chest Wall Mechanics ◽  
Expiratory Flow ◽  
Better Than

Expiratory flow limitation (EFL) and airway closure (AC) were observed in 32% and 52%, respectively, of 25 patients with ARDS investigated during mechanical ventilation in supine position with a positive end-expiratory pressure of 5 cmH2O. The performance of dynamic lung elastance to detect expiratory flow limitation was good and better than that to detect airway closure. The vast majority of patients with EFL also had AC; however, AC can occur in the absence of EFL.

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