Barotrauma vs volutrauma11/26/2022 Since all these patients were ventilated with high tidal volumes and high airway pressures (if they were required), no conclusions about protection from low tidal volumes can be reached. More subtle injuries from over-stretching alveolar walls and capillaries, such as worsening pulmonary edema (alveolar capillary leak) and lung compliance, are more reasonable pathophysiological markers air leaks may not be sensitive at this level of damage. Most significant among these is that the study assumes that conventional markers of barotrauma act as surrogates to identify the proposed "volutrauma" insult of the "baby lung" theory. The study has several significant faults. This is a provocative study that casts doubt on the "baby lung," small-volume ventilation, "lung-protective" strategy being promoted for managing patients with ARDS. Most importantly, no increase in mortality was associated with barotrauma or pneumothorax. In this study using conventional ventilation strategies, no relationship between pressure or volume and development of barotrauma was seen. In evaluating the relationship between increasing airway pressures and ventilation volumes, no relationship to air leak was demonstrated. Serum albumin nadir was slightly lower in the air-leak group (2.2 vs 2.4 g/dL). There were also no differences between the groups with respect to degree of illness as measured by APACHE III scores, highest FiO 2, or oxygenation as measured by PaO 2/FiO 2 ratio. There was no difference in highest peak airway pressure (47 vs 46 cm H 2O), mean airway pressure (24 cm H 2O in both groups), PEEP level (12.6 vs 11.5 cm H 2O), tidal volume in relation to body weight (11.4 vs 11.7 mL/kg), or 30-day mortality (45.5% vs 39%). Patients with air leaks were younger (45 vs 52 years), smaller (72 vs 76 kg), and more likely to be female. There were 77 patients (10.6%) who developed any kind of air leak, including 50 with pneumothorax (6.9%). All patients in the original surfactant study were included. Respiratory variables had been collected every eight hours throughout the period of mechanical ventilation, and the worst values were identified in the control patients (no air leak) and compared to the values immediately preceding the detection of air leak in the barotrauma patients. This has led to nonconventional modes of ventilation in an attempt to prevent this form of iatrogenic "ventilator-induced lung injury." The data analyzed in this paper came from a prospective, randomized, controlled study demonstrating no effect on outcome of aerosolized synthetic surfactant in sepsis-induced adult ARDS (Anzueto A, N Engl J Med 1996 334:1417-1421).ĭata from the 725 patients enrolled in the surfactant study were re-examined for the development of air leak using conventional chest radiography. Nonuniform distribution of involved areas in ARDS has led to a belief that small tidal volume ventilation with low peak airway pressures might protect the lung from further damage. High airway pressures have been blamed for the development of air leaks and worsening of outcome in acute respiratory distress syndrome (ARDS). Is Barotrauma Related to Airway Pressures?
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