2/10/2024 0 Comments Alveolar dead space ardsAt inclusion, median PaO 2/FiO 2 was 173 and median PEEP was 8 cmH 2O. ResultsĮighteen brain-injured patients were studied: 7 (39%) had mild and 11 (61%) had moderate ARDS. Dead space was measured and partitioned by volumetric capnography. Arterial blood gases, static and quasi-static respiratory mechanics, alveolar recruitment by multiple pressure–volume curves, intracranial pressure, cerebral perfusion pressure, mean arterial pressure, and mean flow velocity in the middle cerebral artery by transcranial Doppler were recorded. Methodsīrain-injured patients (head trauma or spontaneous cerebral hemorrhage with Glasgow Coma Scale at admission < 9) with mild and moderate ARDS received three ventilatory strategies in a sequential order during continuous paralysis: (1) HME with V T to obtain a PaCO 2 within 30–35 mmHg (HME1) (2) HH with V T titrated to obtain the same PaCO 2 (HH) and (3) HME1 settings resumed (HME2). Because lowering dead space enhances CO 2 clearance, we conducted a study to determine whether and to what extent replacing heat and moisture exchangers (HME) with heated humidifiers (HH) facilitate safe V T lowering in brain-injured patients with ARDS. ![]() Limiting tidal volume ( V T), plateau pressure, and driving pressure is essential during the acute respiratory distress syndrome (ARDS), but may be challenging when brain injury coexists due to the risk of hypercapnia.
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