Respiratory – Pulmonary – Asthma

critical care

     

• VM
  Ranieri, PM Suter, C Tortorella, et al (Univ of
  Toronto)
  
  Effect
  of Mechanical Ventilation on Inflammatory Mediators
  in Patients with Acute Respiratory Distress
  Syndrome: A Randomized Controlled Trial.
  
  JAMA 282:54-61, 1999
  
     
  
  Mechanical
  ventilation can escalate or cause an inflammatory
  response and acute lung injury.
  The influence of mechanical ventilation on
  the lung and systemic cytokine release was assessed
  in patients with ARDS.
  
    
  
  Two
  groups were assessed (1) a control group and (2) a
  lung protective strategy group.
  
     
  
  At
  baseline physiologic characteristics and cytokine
  concentrations were similar.
  But after 24 and 36 hours, there were
  significant between-group differences in tidal
  volume, end-inspiratory plateau pressures and PEEP. The lung protective strategy group had significantly better
  results. It
  could be concluded that mechanical ventilation can
  produce a cytokine response that may be diminished
  by minimising overdistension and recruitment and
  derecruitment of the lung.