title: Imprecision in lower "inflection point" estimation from static pressure-volume curves in patients at risk for acute respiratory distress syndrome.
abstract: BACKGROUND
  Static pressure-volume (PV) curves have been promoted as a tool for selecting positive end-expiratory pressure (PEEP) by identifying a lower "inflection point" (Pflex) from these curves. Their visual interpretation is subjective and difficult, however, particularly with subtle changes in the slope of the curves. This study was designed to examine the physician-to-physician variability in estimating the lower Pflex from these curves.
  
  
  METHODS
  Static PV curves for eight patients were obtained within 24 hours of admission. Five intensivists and one respiratory therapist independently estimated the lower Pflex from these curves.
  
  
  RESULTS
  Pflex estimates for individual patients were highly variable, ranging from 5 to 9 cm H2O. This variability was not attributable to a single discordant estimate, nor was a single physician responsible for consistently high or low estimates.
  
  
  CONCLUSIONS
  Static PV curve interpretation with current methods imprecisely estimates the lower inflection point and is of limited usefulness in PEEP selection.
authors.affiliation: Department of Surgery, University of Washington, Harborview Medical Center, Seattle, USA.
authors.forename: G E
authors.initials: GE
authors.lastname: O'Keefe
authors.forename: L M
authors.initials: LM
authors.lastname: Gentilello
authors.forename: S
authors.initials: S
authors.lastname: Erford
authors.forename: R V
authors.initials: RV
authors.lastname: Maier
mesh_terms: D006801:Humans; D015588:Observer Variation; D011175:Positive-Pressure Respiration; D012128:Respiratory Distress Syndrome / Q000503:physiopathology* / Q000628:therapy; D012306:Risk; D012307:Risk Factors