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Alveolar derecruitment at decremental positive end-expiratory pressure levels in acute lung injury: comparison with the lower inflection point, oxygenation, and compliance

Maggiore, Salvatore M; Jonson, Björn LU ; Richard, Jean-Christophe; Jaber, Samir; Lemaire, Francois and Brochard, Laurent (2001) In American Journal of Respiratory and Critical Care Medicine 164(5). p.795-801
Abstract
We examined the hypothesis that recording multiple elastic pressure-volume (Pel/V) curves and calculating alveolar derecruitment (V(DER)) induced by decreasing positive end-expiratory pressure (PEEP) may allow determination of alveolar closing pressures, thus helping to select the optimal PEEP level. V(DER) measured in 16 patients with acute lung injury (ALI) was compared with the lower inflection point (LIP) and oxygenation changes. A modified automated method was used to record multiple Pel/V curves at low constant flow. PEEP was decreased in 5-cm H(2)O steps, from 20 or 15 cm H(2)O to 0 cm H(2)O (ZEEP). V(DER) was the volume loss between the curves recorded from PEEP and from ZEEP at the same Pel. Derecruitment occurred at each PEEP... (More)
We examined the hypothesis that recording multiple elastic pressure-volume (Pel/V) curves and calculating alveolar derecruitment (V(DER)) induced by decreasing positive end-expiratory pressure (PEEP) may allow determination of alveolar closing pressures, thus helping to select the optimal PEEP level. V(DER) measured in 16 patients with acute lung injury (ALI) was compared with the lower inflection point (LIP) and oxygenation changes. A modified automated method was used to record multiple Pel/V curves at low constant flow. PEEP was decreased in 5-cm H(2)O steps, from 20 or 15 cm H(2)O to 0 cm H(2)O (ZEEP). V(DER) was the volume loss between the curves recorded from PEEP and from ZEEP at the same Pel. Derecruitment occurred at each PEEP decrement, being spread almost uniformly over the 20/15 to 0 cm H(2)O range. V(DER) was not correlated with LIP. V(DER) changes correlated with Pa(O(2))/FI(O(2)) changes (rho = 0.6, p = 0.02). Linear compliance at ZEEP was correlated to V(DER) at PEEP 15 cm H(2)O (rho = 0.9, p = 0.001), suggesting that compliance above LIP may reflect the amount of recruitable lung. Thus, alveolar closure in ALI occurs over a wide range of pressures, and LIP is a poor predictor of alveolar closure. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
lower inflection point, elastic pressure-volume curves, PEEP, derecruitment, acute lung injury
in
American Journal of Respiratory and Critical Care Medicine
volume
164
issue
5
pages
795 - 801
publisher
Am Thoracic Soc
external identifiers
  • pmid:11549535
  • scopus:0035447951
ISSN
1535-4970
language
English
LU publication?
yes
id
0046dbeb-5f9d-4cbc-babe-d1a1e2ae7b5f (old id 1122775)
alternative location
http://ajrccm.atsjournals.org/cgi/content/full/164/5/795
date added to LUP
2008-07-04 12:35:08
date last changed
2018-05-13 03:32:28
@article{0046dbeb-5f9d-4cbc-babe-d1a1e2ae7b5f,
  abstract     = {We examined the hypothesis that recording multiple elastic pressure-volume (Pel/V) curves and calculating alveolar derecruitment (V(DER)) induced by decreasing positive end-expiratory pressure (PEEP) may allow determination of alveolar closing pressures, thus helping to select the optimal PEEP level. V(DER) measured in 16 patients with acute lung injury (ALI) was compared with the lower inflection point (LIP) and oxygenation changes. A modified automated method was used to record multiple Pel/V curves at low constant flow. PEEP was decreased in 5-cm H(2)O steps, from 20 or 15 cm H(2)O to 0 cm H(2)O (ZEEP). V(DER) was the volume loss between the curves recorded from PEEP and from ZEEP at the same Pel. Derecruitment occurred at each PEEP decrement, being spread almost uniformly over the 20/15 to 0 cm H(2)O range. V(DER) was not correlated with LIP. V(DER) changes correlated with Pa(O(2))/FI(O(2)) changes (rho = 0.6, p = 0.02). Linear compliance at ZEEP was correlated to V(DER) at PEEP 15 cm H(2)O (rho = 0.9, p = 0.001), suggesting that compliance above LIP may reflect the amount of recruitable lung. Thus, alveolar closure in ALI occurs over a wide range of pressures, and LIP is a poor predictor of alveolar closure.},
  author       = {Maggiore, Salvatore M and Jonson, Björn and Richard, Jean-Christophe and Jaber, Samir and Lemaire, Francois and Brochard, Laurent},
  issn         = {1535-4970},
  keyword      = {lower inflection point,elastic pressure-volume curves,PEEP,derecruitment,acute lung injury},
  language     = {eng},
  number       = {5},
  pages        = {795--801},
  publisher    = {Am Thoracic Soc},
  series       = {American Journal of Respiratory and Critical Care Medicine},
  title        = {Alveolar derecruitment at decremental positive end-expiratory pressure levels in acute lung injury: comparison with the lower inflection point, oxygenation, and compliance},
  volume       = {164},
  year         = {2001},
}