title: Ability of dynamic airway pressure curve profile and elastance for positive end-expiratory pressure titration.
abstract: OBJECTIVE
  To evaluate the ability of three indices derived from the airway pressure curve for titrating positive end-expiratory pressure (PEEP) to minimize mechanical stress while improving lung aeration assessed by computed tomography (CT).
  
  
  METHODS
  Prospective, experimental study.
  
  
  METHODS
  University research facilities.
  
  
  METHODS
  Twelve pigs.
  
  
  METHODS
  Animals were anesthetized and mechanically ventilated with tidal volume of 7 ml kg(-1). In non-injured lungs (n = 6), PEEP was set at 16 cmH(2)O and stepwise decreased until zero. Acute lung injury was then induced either with oleic acid (n = 6) or surfactant depletion (n = 6). A recruitment maneuver was performed, the PEEP set at 26 cmH(2)O and decreased stepwise until zero. CT scans were obtained at end-expiratory and end-inspiratory pauses. The elastance of the respiratory system (Ers), the stress index and the percentage of volume-dependent elastance (%E (2)) were estimated.
  
  
  RESULTS
  In non-injured and injured lungs, the PEEP at which Ers was lowest (8-4 and 16-12 cmH(2)O, respectively) corresponded to the best compromise between recruitment/hyperinflation. In non-injured lungs, stress index and %E (2) correlated with tidal recruitment and hyperinflation. In injured lungs, stress index and %E (2) suggested overdistension at all PEEP levels, whereas the CT scans evidenced tidal recruitment and hyperinflation simultaneously.
  
  
  CONCLUSIONS
  During ventilation with low tidal volumes, Ers seems to be useful for guiding PEEP titration in non-injured and injured lungs, while stress index and %E (2) are useful in non-injured lungs only. Our results suggest that Ers can be superior to the stress index and %E (2) to guide PEEP titration in focal loss of lung aeration.
authors.affiliation: Clinic of Anesthesiology and Intensive Care Therapy, Medical Faculty, University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Alysson R
authors.initials: AR
authors.lastname: Carvalho
authors.forename: Peter M
authors.initials: PM
authors.lastname: Spieth
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
authors.forename: Marcos F
authors.initials: MF
authors.lastname: Vidal Melo
authors.forename: Thea
authors.initials: T
authors.lastname: Koch
authors.forename: Frederico C
authors.initials: FC
authors.lastname: Jandre
authors.forename: Antonio
authors.initials: A
authors.lastname: Giannella-Neto
authors.forename: Marcelo Gama
authors.initials: MG
authors.lastname: de Abreu
mesh_terms: D055371:Acute Lung Injury / Q000503:physiopathology* / Q000517:prevention & control; D000818:Animals; D001784:Blood Gas Analysis; D004195:Disease Models, Animal; D005260:Female; D008954:Models, Biological; D011175:Positive-Pressure Respiration / Q000009:adverse effects*; D012129:Respiratory Function Tests; D034421:Sus scrofa