Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Is smaller high enough? Another piece in the puzzle of stress, strain, size, and systems. | Available online http content 13 2 126 Commentary Is smaller high enough Another piece in the puzzle of stress strain size and systems Michael Quintel and Onnen Moerer Department of Anaesthesia and Intensive Care Medicine University of Gottingen Robert Koch Strasse 40 37075 Gottingen Germany Corresponding author Michael Quintel mquintel@ Published 30 March 2009 This article is online at http content 13 2 126 2009 BioMed Central Ltd Critical Care 2009 13 126 doi cc7738 See related research by Zimmermann et al. http content 13 1 R10 Abstract Extracorporeal lung-supporting procedures open the possibility of staying within widely accepted margins of protective mechanical ventilation tidal volume of less than 6 mL per kg of predicted ideal body weight and plateau pressure of less than 30 cm H2O in most any case of respiratory failure or even of further reducing ventilator settings while still providing adequate gas exchange. There is evidence that at least in some patients a further reduction in tidal volumes might be beneficial. Extracorporeal procedures to support the lungs have undergone tremendous technical developments thus reducing the procedure-related risks. However what is true for ventilator settings should also be true for extracorporeal procedures studies will have to demonstrate a convincing riskbenefit ratio. In addition a simple reduction of the tidal volume will certainly not be the right answer. If extracorporeal support largely influences gas exchange the optimal tidal volume positive end-expiratory pressure ratio keeping stress and strain low and avoiding alveolar derecruitment will still have to be individually defined. In the previous issue of Critical Care Zimmermann and colleagues 1 published a prospective observational study in which they applied a pumpless extracorporeal support system to improve gas exchange in a series of 51 patients still fulfilling acute respiratory distress .
