To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: New Measures Needed to Reduce Ventilator-Induced Lung Injury URL: http://www.pslgroup.com/dg/228A3A.htm Doctor's Guide August 15, 2008
NEW YORK -- August 15, 2008 -- Ventilator-induced injury to the lungs can contribute to prolonged respiratory failure and even death among patients with acute respiratory distress syndrome (ARDS). Even postoperative patients with previously healthy lungs, who require temporary mechanical ventilation, are at risk of ventilator-induced lung injury. Such injuries have been reduced tremendously during the last 20 years since studies had demonstrated ventilators should be set to deliver lower tidal volumes so as to reduce the stress and strain on fragile alveoli damaged by ARDS. According to a new study, however, we may have much further to go to reduce ventilator-induced lung injury. To determine whether measurement of plateau pressure is an accurate surrogate measure for lung stress and strain in ARDS patients, Luciano Gattinoni, MD, Istituto di Anestesiologia e Rianimazione, Fondazione IRCCS, Milan, Italy, and colleagues directly measured actual stress and strain in a total of 80 patients, including postsurgical patients, patients with ARDS, patients with acute lung injury (ALI), and patients with a medical disease. They used a number of measurements to measure lung stress and strain, primarily oesophageal pressure and lung volume assessment with helium dilution technique. They found that there was little correlation between plateau pressure and set tidal volume with the actual lung stress and strain in all 4 groups. While plateau pressures and tidal volumes may be reflective of the chest wall elastance and lung volume of the population as a whole, in circumstances where patients require mechanical ventilation, those general guidelines are inadequate to assess the individual's lung stress and strain. "The consequences are, of course, potentially more dangerous in patients in which the chest wall elastance is more compromised and the lung volume is more reduced," said Dr. Gattinoni. "The immediate clinical implications are that clinicians should not trust the conventional measurements." Going forward, Dr. Gattinoni and colleagues would like to see improved measures of lung stress and strain, including routine assessment of oesophageal pressure and lung volumes to compute stress and strain in large populations of mechanically ventilated patients. SOURCE: American Thoracic Society --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.