Pulmonary Barotrauma in Mechanical Ventilation
1993; Elsevier BV; Volume: 104; Issue: 3 Linguagem: Inglês
10.1016/s0012-3692(16)38931-0
ISSN1931-3543
AutoresR. Bruce Gammon, Myung S. Shin, Scott E. Buchalter,
Tópico(s)Pleural and Pulmonary Diseases
ResumoTo the Editor: We appreciate the interest of Dr. Fuhrman and agree that there are many unanswered questions regarding ventilator-associated barotrauma. We did not attempt to compare IMV and assist-control modes of ventilation due to a physician bias in our general medical ICU toward the use of assist-control ventilation in most unstable patients. The 11 patients ventilated with IMV were less ill, and the majority had nonpulmonary diagnoses; no patient with adult respiratory distress syndrome (ARDS) was ventilated with IMV A slightly lower barotrauma rate was seen in the IMV group (1/11 patients with pneumothorax), but we believe this reflected the difference in patient population rather than an inherent advantage of IMV. We were unable to correlate barotrauma risk with patient improvement, and in only one patient with ARDS did a pneumothorax occur when ventilatory pressures were trending down and gas exchange trends were improving. We agree in theory that nonhomogeneous diseases leading to high ventilatory pressures, such as ARDS, may have selective overdistension of less diseased alveoli. A better understanding of the relationship between ventilatory variables and barotrauma is needed to allow better prediction of immediately life-threatening forms of barotrauma, as well as to devise better ventilatory strategies for high-risk patients. Hopefully, future studies will allow us to separate truth from myth. Pulmonary Barotrauma in Mechanical VentilationCHESTVol. 104Issue 3PreviewTb the Editor: Full-Text PDF
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