Parameters derived from the pulmonary pressure volume curve, but not the pressure time curve, indicate recruitment in experimental lung injury.

Abstract:

BACKGROUND:In acute lung injury, ventilation avoiding tidal hyperinflation and tidal recruitment has been proposed to prevent ventilator-associated lung injury. Information about dynamic recruitment may be obtained from the characteristics of pressure-volume (PV) curves or the profile of pressure-time (Paw-t) curves. METHODS:Six anesthetized pigs with lung lavage-induced acute lung injury were ventilated with lung-protective settings. We measured the effects of a standard recruitment maneuver on hysteresis area and ratio obtained from the PV curve and on the stress index obtained from the Paw-t curve and correlated this with aerated and nonaerated lung volumes as measured by multislice computed tomography. RESULTS:Hysteresis area and ratio correlated with aerated lung volume (r = 0.886). The recruitment maneuver resulted in an increase in aerated (+12%) and a decrease (-18%) in nonaerated lung. Hysteresis area correlated with alveolar recruitment, represented by an increase in aerated lung (r = 0.886) and a decrease in nonaerated lung (r = -0.829) during tidal ventilation. The stress index was always >1 and indicated tidal hyperinflation only. Values did not change after the recruitment maneuver and did not correlate with any other lung volume. CONCLUSIONS:Parameters derived from the PV curve may help in characterizing the lung aeration of the lung and in indicating recruitment. In the presence of lung-protective ventilator settings, the stress index derived from the Paw-t curve was not able to indicate recruitment.

journal_name

Anesth Analg

journal_title

Anesthesia and analgesia

authors

Henzler D,Hochhausen N,Dembinski R,Orfao S,Rossaint R,Kuhlen R

doi

10.1213/01.ane.0000278733.94863.09

subject

Has Abstract

pub_date

2007-10-01 00:00:00

pages

1072-8, table of contents

issue

4

eissn

0003-2999

issn

1526-7598

pii

105/4/1072

journal_volume

105

pub_type

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