cmH2OCentimeters of Water
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MIP, (cmH2O), median, IQR###66 (59-74)###53 (48-59)###p<0.001
After tracheal intubation, mechanical ventilation was started with volume control ventilation at the following setting: tidal volume (TV) = 7-8 ml/kg (lean body mass), positive end expiratory pressure (PEEP) = 0 cmH2O, inspiratory/expiratory (I/E) ratio = 1:2, FIO2 = 0.45, and Respiratory Rate (RR) = 12/min.
Variables belonging to the ventilator and the patient before and after extracorporal membrane oxygenation Variable Before ECMO ECMO ECMO (*) 1st hour 24th hour Frequency/min 60 10 10 PIP (cmH2O) 30 23 23 PEEP (cmH2O) 10 8 8 FiO2 1.0 0.3 0,25 pH 6,75 6.99 7,30 pCO2 86 23 42 paO2 44 77 80 SpO2 50,4 88 95 Lactate mmol/L 11,7 16 2,7 PaO2/FiO2 44 Oxygenation constant 46 ECMO: extracorporal membrane oxygenation; FiO2: fraction of inspired oxygen; PIP: peak inspiratory pressure; PEEP: positive end-expiratory pressure; PaCO2: partial arterial cardondioxide pressure; PaO2 : partial arterial oxygen pressure; SpO2 : pulse oxygen saturation, oxygenation index: (MAP x FiO2 x 100)/ PaO2), (*) before cardiac arrrest
When randomized to CPAP, positive pressure was applied using a Neopuff[TM] manual ventilator with PEEP at 5 cmH2O and 100% oxygen.
Recomenda-se que a pressao exercida pelo balonete contra as paredes da traqueia permita um adequado fluxo sanguineo capilar, nao excedendo valores fisiologicos em torno de 25mmHg (30 cmH2O), no entanto, na pratica clinica e comum que as medidas de cuff estejam em desacordo com os valores recomendados na literatura [6,23].
Recomenda-se pressao de plato maxima de 30 cmH2O para pacientes com sindrome de angustia respiratoria aguda.
For plethysmography, the trachea was occluded at end expiration (transrespiratory pressure, [] = 0 cmH2O) and the intercostal muscles were stimulated with intramuscular electrodes to induce inspiratory efforts.
The Mark 9 allowed much higher pressures (up to 260 cmH2O) and flows during inspiration and was famously used by the San Diego Zoo to ventilate an elephant5.
This value should typically be greater than 20-25 cmH2O and is best performed after the RSBI.
This is very important as a high DLPP (over 40 cmH2O) may indicate that the upper tracts are at risk of deterioration because the bladder has lost the ability to fill while maintaining low pressure.
For the measurement of maximal respiratory pressures, a pressure gauge (MICROMEDICAL RPM brand, Micro Medical Limited, PO Box 6, Rochester, Kent ME1 2AZ UK), with a previous vacuum calibration cmH2O every 7 days, with a range of approximately 300 cmH2O of expiratory pressure and inspiratory pressure was used.