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[Effects of the positive end-expiratory pressure increase on sublingual microcirculation in patients with acute respiratory distress syndrome].

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OBJECTIVE The aim of this study was to evaluate the impact of increased positive end-expiratory pressure on the sublingual microcirculation. METHODS Adult patients who were sedated, under mechanical ventilation, and… Click to show full abstract

OBJECTIVE The aim of this study was to evaluate the impact of increased positive end-expiratory pressure on the sublingual microcirculation. METHODS Adult patients who were sedated, under mechanical ventilation, and had a diagnosis of circulatory shock and acute respiratory distress syndrome were included. The positive end-expiratory pressure level was settled to obtain a plateau pressure of 30cmH2O and then maintained at this level for 20minutes. Microcirculatory (obtained by videomicroscopy) and hemodynamic variables were collected at baseline and compared with those at the end of 20min. RESULTS Twelve patients were enrolled. Overall, the microcirculation parameters did not significantly change after increasing the positive end-expiratory pressure. However, there was considerable interindividual variability. There was a negative, moderate correlation between the changes in the De Backer score (r=-0.58, p=0.048), total vessel density (r=-0.60, p=0.039) and baseline values. The changes in total vessel density (r=0.54, p=0.07) and perfused vessel density (r=0.52, p=0.08) trended toward correlating with the changes in the mean arterial pressure. CONCLUSION Overall, the microcirculation parameters did not significantly change after increasing the positive end-expiratory pressure. However, at individual level, such response was heterogeneous. The changes in the microcirculation parameters could be correlated with the baseline values and changes in the mean arterial pressure.

Keywords: end expiratory; positive end; pressure; expiratory pressure

Journal Title: Revista brasileira de anestesiologia
Year Published: 2017

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