PMID- 10551750
OWN - NLM
STAT- MEDLINE
DCOM- 19991118
LR  - 20201208
IS  - 0003-1348 (Print)
IS  - 0003-1348 (Linking)
VI  - 65
IP  - 11
DP  - 1999 Nov
TI  - Pressure control inverse ratio ventilation in the treatment of adult respiratory 
      distress syndrome in patients with blunt chest trauma.
PG  - 1027-30
AB  - The objective of this study was to evaluate the efficacy of pressure control 
      inverse ratio ventilation (PCIRV) in improving oxygenation in trauma patients 
      with adult respiratory distress syndrome (ARDS) and to assess the potential risks 
      associated with this form of treatment. This was a cohort study assessing the 
      trends in hemodynamic and ventilatory parameters after the initiation of PCIRV, 
      conducted at a community Level I trauma center intensive care unit. The study 
      comprised 15 trauma patients developing severe, progressive ARDS [two or more of 
      the following criteria: positive end-expiratory pressure (PEEP) >10 cm H2O; 
      arterial partial pressure of oxygen divided by fraction of inspired oxygen 
      (PaO2:FiO2) ratio <150; and peak inspiratory pressure (PIP) >45 cm H2O]: ten due 
      to blunt chest injuries, three due to sepsis, and two due to fat emboli syndrome. 
      PCIRV was initiated. Main outcome measures were PIP, PEEP (total, auto), oxygen 
      saturation, cardiac index, oxygen delivery, PaO2:FiO2 ratio, compliance, evidence 
      of complications of PCIRV, and mortality. Within 24 hours of conversion to PCIRV, 
      the patients stabilized and the mean PaO2:FiO2 ratio rose from 96.3+/-57.8 to 
      146.8+/-91.1 (P<0.05) and PIP fell from 47.9+/-13.8 to 38.8+/-8.4 cm H2O; 
      auto-PEEP increased from 0.5+/-1.9 to 7.5+/-5.6 cm H2O (P<0.05); oxygen delivery 
      index remained stable (563+/-152 to 497+/-175 mL/min/m2); three patients 
      developed evidence of barotrauma, one patient developed critical illness 
      polyneuropathy, and two patients died (13%). PCIRV is an effective salvage mode 
      of ventilation in patients with severe ARDS, but it is not without complications. 
      Auto-PEEP levels and cardiac index should be monitored to ensure tissue oxygen 
      delivery is maintained.
FAU - McCarthy, M C
AU  - McCarthy MC
AD  - Department of Surgery, Wright State University School of Medicine, Dayton, Ohio 
      45409, USA.
FAU - Cline, A L
AU  - Cline AL
FAU - Lemmon, G W
AU  - Lemmon GW
FAU - Peoples, J B
AU  - Peoples JB
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Disease Progression
MH  - Female
MH  - Hemodynamics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Positive-Pressure Respiration
MH  - Respiration
MH  - Respiration, Artificial/*methods
MH  - Respiratory Distress Syndrome/etiology/physiopathology/*therapy
MH  - Thoracic Injuries/complications
EDAT- 1999/11/07 00:00
MHDA- 1999/11/07 00:01
CRDT- 1999/11/07 00:00
PHST- 1999/11/07 00:00 [pubmed]
PHST- 1999/11/07 00:01 [medline]
PHST- 1999/11/07 00:00 [entrez]
PST - ppublish
SO  - Am Surg. 1999 Nov;65(11):1027-30.