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Pulmonary function stability with PEEP titration maneuver chosen by Rapid versus Slow during a protective ventilatory strategy in pig model

Grant number: 13/16257-0
Support type:Scholarships in Brazil - Doctorate
Effective date (Start): May 01, 2014
Effective date (End): July 31, 2015
Field of knowledge:Health Sciences - Medicine - Medical Clinics
Principal researcher:Marcelo Britto Passos Amato
Grantee:Tatiana de Arruda Ortiz
Home Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil


Introduction: The alveolar recruitment maneuver (ARM) is used in cases of Acute Respiratory distress syndrome (ARDS) for opening alveolar collapsed units in regions dependent on gravity, which can improve oxygenation and reduce the risk of ventilator induced lung injury. After ARM, the appropriate PEEP setting allows to keep alveoli opened. It is still controversial which is the best approach to choose PEEP. The Electrical Impedance Tomography (EIT) has been shown to be a useful bedside tool to assess dynamically regional pulmonary changes, allowing the choice the PEEP which minimizes both the pulmonary collapse in dependent regions and the overdistension in the non-dependent regions, and also allows the assessment of lung function over time. Objectives: In an experimental ARDS model, 1) to compare, using EIT, the best PEEP adjustment by decremental titration using short periods of time (40 seconds in each value of PEEP) with the decremental PEEP titration performed slowly (4 minutes in each PEEP); 2) to use EIT to evaluate pulmonary function stability (evolution of collapse, regional compliance and shunt) during 1 hour of mechanical ventilation in three PEEP values: lower PEEP in fast PEEP titration procedure which determines collapse equal to 0, 1% and 3% of the lung tissue mass; 3) to analyze the hemodynamic variables along the fast and slow titration, as well as during 1 hour period of ventilation in the three values of PEEP; 4) to identify what is the "optimal PEEP" by fast and slow titration, i.e. the lowest PEEP that over time maintains pulmonary stability.

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