%0 Journal Article
%T Feasibility of Setting the Tidal Volume Based on End-Expiratory Lung Volume: A Pilot Clinical Study.
%A Grassi A
%A Teggia-Droghi M
%A Borgo A
%A Szudrinsky K
%A Bellani G
%J Crit Care Explor
%V 6
%N 1
%D 2024 Jan
%M 38234589
暂无%R 10.1097/CCE.0000000000001031
%X <B>OBJECTIVE: </B>To assess the feasibility of setting the tidal volume (TV) as 25% of the actual aerated lung volume (rather than on ideal body weight) in patients with Acute Respiratory Distress Syndrome (ARDS).<BR><B>METHODS: </B>Physiologic prospective single-center pilot study.<BR><B>METHODS: </B>Medical ICU specialized in the care of patients with ARDS.<BR><B>METHODS: </B>Patients with moderate-severe ARDS deeply sedated or paralyzed, undergoing controlled mechanical ventilation with a ventilator able to measure the end-expiratory lung volume (EELV) with a washin, washout technique.<BR><B>METHODS: </B>Three-phase study (baseline, strain-selected TV setting, ventilation with strain-selected TV for 24 hr). The TV was calculated as 25% of the measured EELV minus the static strain due to the applied positive end-expiratory pressure.<BR><B>RESULTS: </B>Gas exchanges and respiratory mechanics were measured and compared in each phase. In addition, during the TV setting phase, driving pressure (DP) and lung strain (TV/EELV) were measured at different TVs to assess the correlation between the two measurements. The maintenance of the set strain-selected TV for 24 hours was safe and feasible in 76% of the patients enrolled. Three patients dropped out from the study because of the need to set a respiratory rate higher than 35 breaths per minute to avoid respiratory acidosis. The DP of the respiratory system was a satisfactory surrogate for strain in this population.<BR><B>CONCLUSIONS: </B>In our population of 17 patients with moderate to severe ARDS, setting TV based on the actual lung size was feasible. DP was a reliable surrogate of strain in these patients, and DP less than or equal to 8 cm H2O corresponded to a strain less than 0.25.