Ability of dynamic airway pressure curve profile and elastance for positive end-expiratory pressure titration.
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.
Carvalho
Alysson R
AR
Clinic of Anesthesiology and Intensive Care Therapy, Medical Faculty, University Hospital Carl Gustav Carus, Dresden, Germany.
Spieth
Peter M
PM
Pelosi
Paolo
P
Vidal Melo
Marcos F
MF
Koch
Thea
T
Jandre
Frederico C
FC
Giannella-Neto
Antonio
A
de Abreu
Marcelo Gama
MG
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