Artículos de publicaciones periódicas

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Dead space analysis at different levels of positive end-expiratory pressure in acute respiratory distress syndrome patients
(2018-06) Gogniat, Emiliano; Ducrey, Marcela; Dianti, José; Madorno, Matías; Roux, Nicolás; Midley, Alejandro; Raffo, Julio; Giannasi, Sergio; San Román, Eduardo; Suárez-Sipmann, Fernando; Tusman, Gerardo
"To analyze the effects of positive end-expiratory pressure (PEEP) on Bohr's dead space (VDBohr/VT) in patients with acute respiratory distress syndrome (ARDS)."
Effect of PEEP on dead space in an experimental model of ARDS
(2020) Tusman, Gerardo; Gogniat, Emiliano; Madorno, Matías; Otero, Pablo; Dianti, José; Fernández Ceballos, Ignacio; Ceballos, Martín; Verdier, Natalí; Böhm, Stephan H.; Rodríguez, Pablo Oscar; San Román, Eduardo
"Background: Difference between Bohr and Enghoff dead space are not well described in ARDS patients. We aimed to analyze the effect of PEEP on the Bohr and Enghoff dead spaces in a model of ARDS. Methods: 10 pigs submitted to randomized PEEP steps of 0, 5, 10, 15, 20, 25 and 30 cm H2O were evaluated with the use of lung ultrasound images, alveolar-arterial oxygen difference (P(A-a)O2), transpulmonary mechanics, and volumetric capnography at each PEEP step. Results: At PEEP > 15 cm H2O, atelectasis and P(A-a)O2 progressively decreased while endinspiratory transpulmonary pressure (PL), end-expiratory PL, and driving PL increased (all P < .001). Bohr dead space (VDBohr/VT), airway dead space (VDaw/VT), and alveolar dead space (VDalv/VTalv) reached their highest values at PEEP 30 cm H2O (0.69 0.10, 0.53 0.13 and 0.35 0.06, respectively). At PEEP <15 cm H2O, the increases in atelectasis and P(A-a)O2 were associated with negative end-expiratory PL and highest driving PL. VDBohr/VT and VDaw/VT showed the lowest values at PEEP 0 cm H2O (0.51 0.08 and 0.32 0.08, respectively), whereas VDalv/VTalv increased to 0.27 0.05. Enghoff dead space and its derived VDalv/VTalv showed high values at low PEEPs (0.86 0.02 and 0.79 0.04, respectively) and at high PEEPs (0.84 0.04 and 0.65 0.12), with the lowest values at 15 cm H2O (0.77 0.05 and 0.61 0.11, respectively; all P < .001). CONCLUSIONS: Bohr dead space was associated to lung stress, whereas Enghoff dead space was partially affected by the shunt effect. Key words: dead space; PEEP; lung stress; ARDS; VILI; carbon dioxide."
Multimodal non‑invasive monitoring to apply an open lung approach strategy in morbidly obese patients during bariatric surgery
(2019) Tusman, Gerardo; Acosta, Cecilia M.; Ochoa, Marcos; Böhm, Stephan H.; Gogniat, Emiliano; Martínez Arca, Jorge; Scandurra, Adriana; Madorno, Matías; Ferrando, Carlos; Suárez-Sipmann, Fernando
"To evaluate the use of non-invasive variables for monitoring an open-lung approach (OLA) strategy in bariatric surgery. Twelve morbidly obese patients undergoing bariatric surgery received a baseline protective ventilation with 8 cmH2O of positive-end expiratory pressure (PEEP). Then, the OLA strategy was applied consisting in lung recruitment followed by a decremental PEEP trial, from 20 to 8 cmH2O, in steps of 2 cmH2O to find the lung’s closing pressure. Baseline ventila-tion was then resumed setting open lung PEEP (OL-PEEP) at 2 cmH2O above this pressure. The multimodal non-invasive variables used for monitoring OLA consisted in pulse oximetry (SpO2), respiratory compliance (Crs), end-expiratory lung volume measured by a capnodynamic method (EELVCO2), and esophageal manometry. OLPEEP was detected at 15.9 ± 1.7 cmH2O corresponding to a positive end-expiratory transpulmonary pressure (PL,ee) of 0.9 ± 1.1 cmH2O. ROC analysis showed that SpO2 was more accurate (AUC 0.92, IC95% 0.87–0.97) than Crs (AUC 0.76, IC95% 0.87–0.97) and EELVCO2 (AUC 0.73, IC95% 0.64–0.82) to detect the lung’s closing pressure according to the change of PL,ee from positive to negative values. Compared to baseline ventilation with 8 cmH2O of PEEP, OLA increased EELVCO2 (1309 ± 517 vs. 2177 ± 679 mL) and decreased driving pressure (18.3 ± 2.2 vs. 10.1 ± 1.7 cmH2O), estimated shunt (17.7 ± 3.4 vs. 4.2 ± 1.4%), lung strain (0.39 ± 0.07 vs. 0.22 ± 0.06) and lung elastance (28.4 ± 5.8 vs. 15.3 ± 4.3 cmH2O/L), respectively; all p < 0.0001. The OLA strategy can be monitored using noninvasive variables during bariatric surgery. This strategy decreased lung strain, elastance and driving pressure compared with standard protective ventilatory settings."

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