+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Gastric intramucosal pH is stable during titration of positive end-expiratory pressure to improve oxygenation in acute respiratory distress syndrome



Gastric intramucosal pH is stable during titration of positive end-expiratory pressure to improve oxygenation in acute respiratory distress syndrome



Critical Care 7(3): R17-R23



Optimal positive end-expiratory pressure (PEEP) is an important component of adequate mechanical ventilation in acute lung injury and acute respiratory distress syndrome (ARDS). In the present study we tested the effect on gastric intramucosal pH of incremental increases in PEEP level (i.e. PEEP titration) to improve oxygenation in ARDS. Seventeen consecutive patients with ARDS, as defined by consensus criteria, were included in this clinical, prospective study. All patients were haemodynamically stable, and were not receiving vasopressors. From an initial level of 5 cmH2O, PEEP was titrated at 2 cmH2O increments until the partial arterial oxygen tension was 300 mmHg or greater, peak airway pressure was 45 cmH2O or greater, or mean arterial blood pressure decreased by 20% or more of the baseline value. Optimal PEEP was defined as the level of PEEP that achieved the best oxygenation. The maximum PEEP was the highest PEEP level reached during titration in each patient. Gastric mucosal pH was measured using gastric tonometry at all levels of PEEP. The thermodilution technique was used for measurement of cardiac index. Gastric mucosal pH was similar at baseline and at optimal PEEP levels, but it was slightly reduced at maximum PEEP. Cardiac index and oxygen delivery remained stable at all PEEP levels. Incremental titration of PEEP based on improvement in oxygenation does not decrease gastric intramucosal perfusion when cardiac output is preserved in patients with ARDS.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 049136414

Download citation: RISBibTeXText

PMID: 12793886

DOI: 10.1186/cc2172


Related references

Effects of inverse ratio ventilation versus positive end-expiratory pressure on gas exchange and gastric intramucosal PCO(2) and pH under constant mean airway pressure in acute respiratory distress syndrome. Anesthesiology 95(5): 1182-1188, 2001

Titration of the optimal positive end-expiratory pressure and its prognostic value in acute respiratory distress syndrome. Zhonghua Jie he He Hu Xi Za Zhi 30(10): 733-737, 2007

Titration of the optimal positive end-expiratory pressure and its prognostic value in acute respiratory distress syndrome. 2007

Respiratory and haemodynamic changes during decremental open lung positive end-expiratory pressure titration in patients with acute respiratory distress syndrome. Critical Care 13(2): R59, 2009

Hemodynamic and respiratory changes during lung recruitment and descending optimal positive end-expiratory pressure titration with acute respiratory distress syndrome. Critical Care Medicine 35(8): 1998-9; Author Reply 1999, 2007

Lung Recruitment and Positive End-Expiratory Pressure Titration in Patients With Acute Respiratory Distress Syndrome. JAMA 319(9): 933, 2018

Pulmonary acute respiratory distress syndrome: positive end-expiratory pressure titration needs stress index. Journal of Surgical Research 185(1): 347-352, 2013

Hemodynamic and respiratory changes during lung recruitment and descending optimal positive end-expiratory pressure titration in patients with acute respiratory distress syndrome. Yearbook of Anesthesiology and Pain Management 2008: 165-166, 2008

Hemodynamic and respiratory changes during lung recruitment and descending optimal positive end-expiratory pressure titration in patients with acute respiratory distress syndrome. Critical Care Medicine 35(3): 787-793, 2007

Positive end expiratory pressure titrated by transpulmonary pressure improved oxygenation and respiratory mechanics in acute respiratory distress syndrome patients with intra-abdominal hypertension. Chinese Medical Journal 126(17): 3234-3239, 2013

Positive end-expiratory pressure titration with electrical impedance tomography and pressure-volume curve in severe acute respiratory distress syndrome. Annals of Intensive Care 9(1): 7, 2019

Effect of transpulmonary pressure-guided positive end-expiratory pressure titration on lung injury in pigs with acute respiratory distress syndrome. Journal of Clinical Monitoring and Computing 2019:, 2019

Lung recruitment maneuvers and positive end-expiratory pressure titration in children with acute respiratory distress syndrome. Zhongguo Dang Dai Er Ke Za Zhi 20(9): 706-712, 2018

Setting Positive End-Expiratory Pressure in Pediatric Acute Respiratory Distress Syndrome: Cookbook or Individualized Titration?. American Journal of Respiratory and Critical Care Medicine 198(6): 822-823, 2018

Variable effect of positive end-expiratory pressure on oxygenation in patients with acute respiratory distress syndrome. Anesthesiology 108(1): 165; Author Reply 165-6, 2008