{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T10:32:55Z","timestamp":1775471575733,"version":"3.50.1"},"reference-count":37,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T00:00:00Z","timestamp":1658188800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2022,10]]},"abstract":"\n BACKGROUND:<\/jats:title>\n \n The aim of this study was to define the level of peak inspiratory pressure (PIP) and mean airway pressure (\n \n \n \n \n \n \n P<\/mml:mtext>\n \u00af<\/mml:mo>\n <\/mml:mover>\n <\/mml:mrow>\n \n a<\/mml:mtext>\n w<\/mml:mi>\n <\/mml:mrow>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:inline-formula>\n ) at which a pneumothorax is produced in an in vivo ARDS neonate model. In addition, we analyzed the hemodynamic response and cerebral parameters during the progressive increase of intrathoracic pressure.\n <\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n \n We designed a prospective, experimental study with 11 Landrace \u00d7 Large White pigs < 48 h from their birth. With the pigs under general anesthesia, tracheal intubation, invasive hemodynamic monitoring with a pediatric arterial thermodilution catheter, intracranial pressure, cerebral oximetry through near-infrared spectroscopy, and bilateral chest tube catheterization were performed. The ARDS model was developed with bronchoalveolar lavages. The rise in inspiratory pressure was performed achieved by increasing PEEP in stepwise increments at a constant driving pressure. PEEP was increased 5 cm H\n 2<\/jats:sub>\n O every 2 min until a pneumothorax was observed. A descriptive analysis, a Kaplan-Meier curve, and a regression analysis by using a generalized estimation equation were performed.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n A pneumothorax was observed in a median (interquartile range [IQR])\n \n \n \n \n \n P<\/mml:mtext>\n \u00af<\/mml:mo>\n <\/mml:mover>\n aw<\/mml:mtext>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:inline-formula>\n of 54 (46\u201356) cm H\n 2<\/jats:sub>\n O and median (IQR) PIP of 65 (58\u201373) cm H\n 2<\/jats:sub>\n O; asystole at median (IQR)\n \n \n \n \n \n P<\/mml:mtext>\n \u00af<\/mml:mo>\n <\/mml:mover>\n aw<\/mml:mtext>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:inline-formula>\n of 49 (36\u201354) cm H\n 2<\/jats:sub>\n O and median (IQR) PIP of 60 (48\u201365) cm H\n 2<\/jats:sub>\n O. Hemodynamic changes in the median artery pressure, cardiac output, and myocardial contractility were observed above the range of\n \n \n \n \n \n P<\/mml:mtext>\n \u00af<\/mml:mo>\n <\/mml:mover>\n aw<\/mml:mtext>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:inline-formula>\n of 14 cm H\n 2<\/jats:sub>\n O (PIP 25 and PEEP 10 cm H\n 2<\/jats:sub>\n O). Disturbances in intracranial pressure and cerebral oximetry through near-infrared spectroscopy appeared when deep hypotension and asystole occurred.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n A progressive increase of PEEP at a constant driving pressure did not increase severe adverse events at the range of pressures that we routinely use in neonates with ARDS. Asystole, pneumothorax, and cerebral compromise appeared at high intrathoracic ranges of pressure. Hemodynamics must be strictly monitored in all patients during the performance of lung recruitment maneuvers because hemodynamic deflections emerge early, at a range of pressures commonly used in ventilated neonates with ARDS.<\/jats:p>\n <\/jats:sec>","DOI":"10.4187\/respcare.09739","type":"journal-article","created":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T13:30:11Z","timestamp":1658237411000},"page":"1300-1309","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Safe Inspiratory Pressures Threshold in Lung Recruitment Maneuvers: An In Vivo Neonatal ARDS Model"],"prefix":"10.1177","volume":"67","author":[{"given":"Alberto","family":"Guti\u00e9rrez Mart\u00ednez","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Pain, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ver\u00f3nica","family":"Guill\u00f3 Moreno","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Pain, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mart\u00edn","family":"Santos","sequence":"additional","affiliation":[{"name":"Medical and Surgical Research Unit, Instituto de Investigaci\u00f3n Sanitaria Puerta de Hierro-Segovia de Arana. Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c1lvaro","family":"Mingote Llad\u00f3","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Pain, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricio","family":"Gonz\u00e1lez-Pizarro","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Pain, Hospital Universitario La Paz, Madrid, Spain."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"Garc\u00eda-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Pain, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,7,19]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.21907"},{"issue":"23","key":"e_1_3_3_3_2","first-page":"2526","article-title":"Acute respiratory distress syndrome: the Berlin Definition","volume":"307","author":"ARDS Definition Task Force;","year":"2012","unstructured":"ARDS Definition Task Force;. Ranieri VM, , Rubenfeld GD, , Thompson BT, , Ferguson ND, , Caldwell E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012; 307(23):2526-2533.","journal-title":"JAMA"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.22729"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200301000-00006"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.04250"},{"issue":"3","key":"e_1_3_3_7_2","first-page":"CD009969","article-title":"Lung recruitment manoeuvres for reducing mortality and respiratory morbidity in mechanically ventilated neonates","volume":"3","author":"Blazek EV","year":"2021","unstructured":"Blazek EV, , East CE, , Jauncey-Cooke J, , Bogossian F, , Grant CA, , Hough J. Lung recruitment manoeuvres for reducing mortality and respiratory morbidity in mechanically ventilated neonates. 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