The importance of chest wall elastance in characterizing acute lung injury/acute respiratory distress syndrome patients and in setting mechanical ventilation is increasingly recognized. Nearly 30% of patients admitted to a general intensive care unit have an abnormal high intra-abdominal pressure (due to ascites, bowel edema, ileus), which leads to an increase in the chest wall elastance. At a given applied airway pressure, the pleural pressure increases according to (in the static condition) the equation: pleural pressure = airway pressure x (chest wall elastance/total respiratory system elastance). Consequently, for a given applied pressure, the increase in pleural pressure implies a decrease in transpulmonary pressure (airway pressure - pleural pressure), which is the distending force of the lung, implies a decrease of the strain and of ventilator-induced lung injury, implies the need to use a higher airway pressure during the recruitment maneuvers to reach a sufficient transpulmonary opening pressure, implies hemodynamic risk due to the reductions in venous return and heart size, and implies a possible increase of lung edema, partially due to the reduced edema clearance. It is always important in the most critically ill patients to assess the intra-abdominal pressure and the chest wall elastance.
Bench-to-bedside review : chest wall elastance in acute lung injury/acute respiratory distress syndrome patients / L. Gattinoni, D. Chiumello, E. Carlesso, F. Valenza. - In: CRITICAL CARE. - ISSN 1466-609X. - 8:5(2004), pp. 350-355.
|Titolo:||Bench-to-bedside review : chest wall elastance in acute lung injury/acute respiratory distress syndrome patients|
GATTINONI, LUCIANO (Primo)
CARLESSO, ELEONORA (Penultimo)
VALENZA, FRANCO (Ultimo)
|Parole Chiave:||Acute respiratory distress syndrome; Chest wall elastance; Intra-abdominal pressure; Pleural pressure; Ventilator-induced lung injury|
|Settore Scientifico Disciplinare:||Settore MED/41 - Anestesiologia|
|Data di pubblicazione:||2004|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1186/cc2854|
|Appare nelle tipologie:||01 - Articolo su periodico|