ArticleAnesthesiology2014
Higher levels of spontaneous breathing induce lung recruitment and reduce global stress/strain in experimental lung injury.
Article in Anesthesiology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03201263 (PRessure suppOrT vEntilation + Sigh in aCuTe hypoxemIc respiratOry Failure patieNts), which is not on this map. Cited by 22 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
PRessure suppOrT vEntilation + Sigh in aCuTe hypoxemIc respiratOry Failure patieNts (PROTECTION): a Pilot Randomized Controlled Trial
Who cites it
22 citing papers in PubMed, 51 citations in OpenAlex.
- Awake Prone Positioning in Non-Intubated Non-COVID-19 ARDS: A Comprehensive Review.Advances in respiratory medicine · 2026Review
- Advancing thoracic surgery: the clinical, economic, and environmental promise of nonintubated video-assisted thoracoscopic surgery (NIVATS).British journal of anaesthesia · 2025Article
- Regional lung volume changes with noninvasive positive pressure ventilation in healthy adults.Journal of applied physiology (Bethesda, Md. : 1985) · 2025Article
- Noninvasive respiratory support in the emergency department: Controversies and state-of-the-art recommendations.Journal of the American College of Emergency Physicians open · 2024Review
- Positive end-expiratory pressure limits inspiratory effort through modulation of the effort-to-drive ratio: an experimental crossover study.Intensive care medicine experimental · 2024Article
- Effect of spontaneous breathing on ventilator-free days in critically ill patients-an analysis of patients in a large observational cohort.Annals of translational medicine · 2021Article
- Risk Factors for the Development of Intraoperative Hypoxia in Patients Undergoing Nonintubated Video-Assisted Thoracic Surgery: A Retrospective Study from a Single Center.Medical science monitor : international medical journal of experimental and clinical research · 2021Article
- Automatic Lung Segmentation and Quantification of Aeration in Computed Tomography of the Chest Using 3D Transfer Learning.Frontiers in physiology · 2021Article
- Airway Pressure Release Ventilation Mode Improves Circulatory and Respiratory Function in Patients After Cardiopulmonary Bypass, a Randomized Trial.Frontiers in physiology · 2021Article
- Effects of Positive End-Expiratory Pressure and Spontaneous Breathing Activity on Regional Lung Inflammation in Experimental Acute Respiratory Distress Syndrome.Critical care medicine · 2019Article
- Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study.Critical care medicine · 2019Observational
- The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment-Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress Syndrome.Frontiers in physiology · 2019Article
- Article
- Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndrome.Intensive care medicine · 2017Article
- Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effort.Annals of intensive care · 2017Article
- [Acute respiratory distress syndrome : Basic principles and treatment].Der Anaesthesist · 2017Review
- An experimental study on the impacts of inspiratory and expiratory muscles activities during mechanical ventilation in ARDS animal model.Scientific reports · 2017Article
- Article
- The 30-year evolution of airway pressure release ventilation (APRV).Intensive care medicine experimental · 2016Review
- Lung protective ventilation (ARDSNet) versus airway pressure release ventilation: ventilatory management in a combined model of acute lung and brain injury.The journal of trauma and acute care surgery · 2015Article
Corrections and comments
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Authors and funding
14 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSpontaneous breathing (SB) in the early phase of the acute respiratory distress syndrome is controversial. Biphasic positive airway pressure/airway pressure release ventilation (BIPAP/APRV) is commonly used, but the level of SB necessary to maximize potential beneficial effects is unknown.
methodsExperimental acute respiratory distress syndrome was induced by saline lung lavage in anesthetized and mechanically ventilated pigs (n = 12). By using a Latin square and crossover design, animals were ventilated with BIPAP/APRV at four different levels of SB in total minute ventilation (60 min each): (1) 0% (BIPAP/APRV0%); (2) greater than 0 to 30% (BIPAP/APRV>0-30%); (3) greater than 30 to 60% (BIPAP/APRV>30-60%); and (4) greater than 60% (BIPAP/APRV>60%). Gas exchange, hemodynamics, and respiratory variables were measured. Lung aeration was assessed by high-resolution computed tomography. The distribution of perfusion was marked with Ga-labeled microspheres and evaluated by positron emission tomography.
resultsThe authors found that higher levels of SB during BIPAP/APRV (1) improved oxygenation; (2) decreased mean transpulmonary pressure (stress) despite increased inspiratory effort; (3) reduced nonaerated lung tissue, with minimal changes in the distribution of perfusion, resulting in decreased low aeration/perfusion zones; and (4) decreased global strain (mean ± SD) (BIPAP/APRV0%: 1.39 ± 0.08; BIPAP/APRV0-30%: 1.33 ± 0.03; BIPAP/APRV30-60%: 1.27 ± 0.06; BIPAP/APRV>60%: 1.25 ± 0.04, P < 0.05 all vs. BIPAP/APRV0%, and BIPAP/APRV>60% vs. BIPAP/APRV0-30%).
conclusionsIn a saline lung lavage model of experimental acute respiratory distress syndrome in pigs, levels of SB during BIPAP/APRV higher than currently recommended for clinical practice, that is, 10 to 30%, improve oxygenation by increasing aeration in dependent lung zones without relevant redistribution of perfusion. In presence of lung recruitment, higher levels of SB reduce global stress and strain despite an increase in inspiratory effort.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.