ArticleCritical care (London, England)2012
Matching positive end-expiratory pressure to intra-abdominal pressure improves oxygenation in a porcine sick lung model of intra-abdominal hypertension.
Article in Critical care (London, England), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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15 citing papers in PubMed, 44 citations in OpenAlex.
- Beyond the Lungs: Extrapulmonary Effects of Non-Invasive and Invasive Ventilation Strategies.Journal of clinical medicine · 2025Review
- Risk Factors of Enternal Nutrition Intolerance in Septic Patients: A Case-control Study.Current medical science · 2024Article
- Article
- Computed tomographic assessment of lung aeration at different positive end-expiratory pressures in a porcine model of intra-abdominal hypertension and lung injury.Intensive care medicine experimental · 2021Article
- Effect of mechanical ventilation versus spontaneous breathing on abdominal edema and inflammation in ARDS: an experimental porcine model.BMC pulmonary medicine · 2020Article
- Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know.Annals of intensive care · 2019Review
- The respiratory pressure-abdominal volume curve in a porcine model.Intensive care medicine experimental · 2017Article
- Article
- The effects of airway pressure release ventilation on respiratory mechanics in extrapulmonary lung injury.Intensive care medicine experimental · 2015Article
- Adjusting tidal volume to stress index in an open lung condition optimizes ventilation and prevents overdistension in an experimental model of lung injury and reduced chest wall compliance.Critical care (London, England) · 2015Article
- Observational
- The biological effects of higher and lower positive end-expiratory pressure in pulmonary and extrapulmonary acute lung injury with intra-abdominal hypertension.Critical care (London, England) · 2014Article
- Year in review 2012: Critical Care--Respirology.Critical care (London, England) · 2013Review
- Mechanical ventilation and intra-abdominal hypertension: 'Beyond Good and Evil'.Critical care (London, England) · 2012Article
- Chest wall effect on the monitoring of respiratory mechanics in acute respiratory distress syndrome.Revista Brasileira de terapia intensivaReview
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Authors and funding
8 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIntra-abdominal hypertension (IAH) causes atelectasis, reduces lung volumes and increases respiratory system elastance. Positive end-expiratory pressure (PEEP) in the setting of IAH and healthy lungs improves lung volumes but not oxygenation. However, critically ill patients with IAH often suffer from acute lung injury (ALI). This study, therefore, examined the respiratory and cardiac effects of positive end-expiratory pressure in an animal model of IAH, with sick lungs.
methodsNine pigs were anesthetized and ventilated (48 +/- 6 kg). Lung injury was induced with oleic acid. Three levels of intra-abdominal pressure (baseline, 18, and 22 mmHg) were randomly generated. At each level of intra-abdominal pressure, three levels of PEEP were randomly applied: baseline (5 cmH2O), moderate (0.5 × intra-abdominal pressure), and high (1.0 × intra-abdominal pressure). We measured end-expiratory lung volumes, arterial oxygen levels, respiratory mechanics, and cardiac output 10 minutes after each new IAP and PEEP setting.
resultsAt baseline PEEP, IAH (22 mmHg) decreased oxygen levels (-55%, P <0.001) and end-expiratory lung volumes (-45%, P = 0.007). At IAP of 22 mmHg, moderate and high PEEP increased oxygen levels (+60%, P = 0.04 and +162%, P <0.001) and end-expiratory lung volume (+44%, P = 0.02 and +279%, P <0.001) and high PEEP reduced cardiac output (-30%, P = 0.04). Shunt and dead-space fraction inversely correlated with oxygen levels and end-expiratory lung volumes. In the presence of IAH, lung, chest wall and respiratory system elastance increased. Subsequently, PEEP decreased respiratory system elastance by decreasing chest wall elastance.
conclusionsIn a porcine sick lung model of IAH, PEEP matched to intra-abdominal pressure led to increased lung volumes and oxygenation and decreased chest wall elastance shunt and dead-space fraction. High PEEP decreased cardiac output. The study shows that lung injury influences the effects of IAH and PEEP on oxygenation and respiratory mechanics. Our findings support the application of PEEP in the setting of acute lung injury and IAH.
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