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Influence of tidal volume on alveolar recruitment. Respective role of PEEP and a recruitment maneuver

Richard, Jean-Christophe; Maggiore, Salvatore M; Jonson, Björn LU ; Mancebo, Jordi; Lemaire, Francois and Brochard, Laurent (2001) In American Journal of Respiratory and Critical Care Medicine 163(7). p.1609-1613
Abstract
Both reduction in tidal volume (VT) and alveolar recruitment may be important to limit ventilator-associated lung injury during mechanical ventilation of patients with the acute respiratory distress syndrome (ARDS). The aim of this study was to assess the risk of alveolar derecruitment associated with VT reduction from 10 to 6 ml/kg. Whether this VT-related derecruitment could be reversed, either by a recruitment maneuver or by an increase in positive end-expiratory pressure (PEEP) level, was also investigated. Fifteen patients with ARDS were successively ventilated using conventional VT (CVT = 10 +/- 1 ml/kg) and low VT (LVT = 6 +/- 1 ml/ kg); total PEEP (PEEPtot) was individually set at the lower inflection point (Plip) of the... (More)
Both reduction in tidal volume (VT) and alveolar recruitment may be important to limit ventilator-associated lung injury during mechanical ventilation of patients with the acute respiratory distress syndrome (ARDS). The aim of this study was to assess the risk of alveolar derecruitment associated with VT reduction from 10 to 6 ml/kg. Whether this VT-related derecruitment could be reversed, either by a recruitment maneuver or by an increase in positive end-expiratory pressure (PEEP) level, was also investigated. Fifteen patients with ARDS were successively ventilated using conventional VT (CVT = 10 +/- 1 ml/kg) and low VT (LVT = 6 +/- 1 ml/ kg); total PEEP (PEEPtot) was individually set at the lower inflection point (Plip) of the pressure-volume curve (PEEPtot = 11 +/- 4 cm H(2)O). Pressure-volume curves were recorded from zero PEEP (ZEEP) and from PEEP, and recruited volume (Vrec) was calculated as the volume difference between the two curves for a given pressure. Despite a similar PEEPtot, Vrec was significantly lower with LVT than with CVT, indicating low VT-induced alveolar derecruitment. Reduction in VT was associated with a reduced Sa(O(2)). In 10 patients, Vrec was also measured before and after a recruitment maneuver (two sustained inflations at 45 cm H(2)O), and after an increase in PEEP (by 4 cm H(2)O). Low VT-induced derecruitment was reversed by a recruitment maneuver and by increasing PEEP. We conclude that a reduction in VT could be responsible for alveolar derecruitment, which may be transiently reversed by a reexpansion maneuver or prevented by a PEEP increase above Plip. (Less)
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author
organization
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Contribution to journal
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published
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in
American Journal of Respiratory and Critical Care Medicine
volume
163
issue
7
pages
1609 - 1613
publisher
Am Thoracic Soc
external identifiers
  • pmid:11401882
  • scopus:0034959694
ISSN
1535-4970
language
English
LU publication?
yes
id
225f9cf0-ffbe-4d2f-b05e-d2966deccce4 (old id 1122812)
alternative location
http://ajrccm.atsjournals.org/cgi/content/full/163/7/1609
date added to LUP
2008-07-11 13:48:25
date last changed
2018-07-15 03:32:05
@article{225f9cf0-ffbe-4d2f-b05e-d2966deccce4,
  abstract     = {Both reduction in tidal volume (VT) and alveolar recruitment may be important to limit ventilator-associated lung injury during mechanical ventilation of patients with the acute respiratory distress syndrome (ARDS). The aim of this study was to assess the risk of alveolar derecruitment associated with VT reduction from 10 to 6 ml/kg. Whether this VT-related derecruitment could be reversed, either by a recruitment maneuver or by an increase in positive end-expiratory pressure (PEEP) level, was also investigated. Fifteen patients with ARDS were successively ventilated using conventional VT (CVT = 10 +/- 1 ml/kg) and low VT (LVT = 6 +/- 1 ml/ kg); total PEEP (PEEPtot) was individually set at the lower inflection point (Plip) of the pressure-volume curve (PEEPtot = 11 +/- 4 cm H(2)O). Pressure-volume curves were recorded from zero PEEP (ZEEP) and from PEEP, and recruited volume (Vrec) was calculated as the volume difference between the two curves for a given pressure. Despite a similar PEEPtot, Vrec was significantly lower with LVT than with CVT, indicating low VT-induced alveolar derecruitment. Reduction in VT was associated with a reduced Sa(O(2)). In 10 patients, Vrec was also measured before and after a recruitment maneuver (two sustained inflations at 45 cm H(2)O), and after an increase in PEEP (by 4 cm H(2)O). Low VT-induced derecruitment was reversed by a recruitment maneuver and by increasing PEEP. We conclude that a reduction in VT could be responsible for alveolar derecruitment, which may be transiently reversed by a reexpansion maneuver or prevented by a PEEP increase above Plip.},
  author       = {Richard, Jean-Christophe and Maggiore, Salvatore M and Jonson, Björn and Mancebo, Jordi and Lemaire, Francois and Brochard, Laurent},
  issn         = {1535-4970},
  language     = {eng},
  number       = {7},
  pages        = {1609--1613},
  publisher    = {Am Thoracic Soc},
  series       = {American Journal of Respiratory and Critical Care Medicine},
  title        = {Influence of tidal volume on alveolar recruitment. Respective role of PEEP and a recruitment maneuver},
  volume       = {163},
  year         = {2001},
}