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Lung opening and closing during ventilation of acute respiratory distress syndrome.

Abstract：

RATIONALE:The effects of high positive end-expiratory pressure (PEEP) strictly depend on lung recruitability, which varies widely during acute respiratory distress syndrome (ARDS). Unfortunately, increasing PEEP may lead to opposing effects on two main factors potentially worsening the lung injury, that is, alveolar strain and intratidal opening and closing, being detrimental (increasing the former) or beneficial (decreasing the latter). OBJECTIVES:To investigate how lung recruitability influences alveolar strain and intratidal opening and closing after the application of high PEEP. METHODS:We analyzed data from a database of 68 patients with acute lung injury or ARDS who underwent whole-lung computed tomography at 5, 15, and 45 cm H(2)O airway pressure. MEASUREMENTS AND MAIN RESULTS:End-inspiratory nonaerated lung tissue was estimated from computed tomography pressure-volume curves. Alveolar strain and opening and closing lung tissue were computed at 5 and 15 cm H(2)O PEEP. In patients with a higher percentage of potentially recruitable lung, the increase in PEEP markedly reduced opening and closing lung tissue (P < 0.001), whereas no differences were observed in patients with a lower percentage of potentially recruitable lung. In contrast, alveolar strain similarly increased in the two groups (P = 0.89). Opening and closing lung tissue was distributed mainly in the dependent and hilar lung regions, and it appeared to be an independent risk factor for death (odds ratio, 1.10 for each 10-g increase). CONCLUSIONS:In ARDS, especially in patients with higher lung recruitability, the beneficial impact of reducing intratidal alveolar opening and closing by increasing PEEP prevails over the effects of increasing alveolar strain.

journal_name

Am J Respir Crit Care Med

journal_title

American journal of respiratory and critical care medicine

authors

Caironi P,Cressoni M,Chiumello D,Ranieri M,Quintel M,Russo SG,Cornejo R,Bugedo G,Carlesso E,Russo R,Caspani L,Gattinoni L

doi

10.1164/rccm.200905-0787OC

subject

Has Abstract

pub_date

2010-03-15 00:00:00

pages

578-86

issue

eissn

1073-449X

issn

1535-4970

pii

200905-0787OC

journal_volume

181

pub_type

杂志文章,多中心研究

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Lung opening and closing during ventilation of acute respiratory distress syndrome.