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Pressure‐volume relationships in acute lung injury: methodological and clinical implications
Author(s) -
Nunes S.,
Uusaro A.,
Takala J.
Publication year - 2004
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.0001-5172.2004.0313.x
Subject(s) - medicine , plethysmograph , positive end expiratory pressure , respiratory physiology , lung volumes , respiratory system , anesthesia , volume (thermodynamics) , lung , cardiology , mechanical ventilation , thermodynamics , physics
Background:  Pressure‐volume relationships (PV curves) are the only available method for bedside monitoring of respiratory mechanics. Alveolar recruitment modifies the results obtained from the PV curves. We hypothesized that method‐related differences may influence PV‐curve guided ventilatory management. Methods:  Twelve acute lung injury (ALI) patients [PaO 2 /FiO 2 13.0 ± 1.5 kPa (97.6 ± 11.3 mmHg), bilateral pulmonary infiltrates] were studied. Two PV curves [one at variable, and another at constant level of positive end‐expiratory pressure (PEEP)] were obtained from each patient using constant inspiratory flow and end‐inspiratory and ‐expiratory occlusions. Upper and lower inflection points (UIP, LIP) were estimated. Recruitment due to PEEP and during inflation was assessed by respiratory inductive plethysmography (RIP). Results:  (1) Pressure‐volume curves at constant PEEP tended to provide higher LIP values compared with curves at variable PEEP (mean difference  ± SEM 5.1 ± 1.9 cmH 2 O); and (2) recruitment occurred throughout the PV curve with no relationship with LIP or UIP. Conclusion:  Pressure‐volume curves obtained using variable PEEP translate a different physiological reality and seem to be clinically more relevant than curves constructed at constant PEEP. If curves constructed at constant PEEP are used to set the ventilator, unnecessarily high PEEP levels may be used. Respiratory inductive plethysmography technology may be used for monitoring of recruitment at the bedside.

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