title: Recruitment and PEEP level influences long-time aeration in saline-lavaged piglets: an experimental model.
abstract: OBJECTIVE
  To evaluate aeration/ventilation in saline-lavaged piglets during a 3-h follow-up after a recruitment maneuver (RM)/PEEP titration compared with PEEP 10 cmH2O without a RM.
  
  
  BACKGROUND
  Lung recruitment and PEEP titration are used to find a PEEP preventing repetitive opening/collapsing of lung.
  
  
  METHODS
  Twenty-one lung-lavaged piglets, mean age 7 weeks and mean weight 10 kg; a RM-group and a PEEP10-group, were ventilated at PEEP 5 cmH2O (baseline) followed by zero PEEP ventilation. In the RM-group, tidal elimination of CO2 and dynamic compliance (Cdyn) guided recruitment and PEEP titration, respectively. A final 3-h ventilation followed using PEEP 2 cmH2O above the first decline of Cdyn and end-inspiratory pressure (EIP) for a target tidal volume (VT) of 10 ml · kg(-1). In the PEEP10-group, PEEP 10 cmH2O without a RM was used during the final 3-h ventilation. CT scans and blood gases were repeated every 30 min. Airway pressures, Cdyn and hemodynamics were continuously recorded.
  
  
  RESULTS
  Aeration improved without differences between groups. The RM-group PEEP level of 10 ± 0.6 cmH2O did not differ from the PEEP10-group. Compared to baseline EIP was lower in the RM-group after 3-h ventilation. In both groups, driving pressure (DP) was lower and Cdyn higher than baseline. In the RM-group, final EIP and DP were lower and Cdyn higher than in the PEEP10-group.
  
  
  CONCLUSIONS
  Both RM/PEEP titration and PEEP elevation resulted in improved aeration without differences between groups at the end point. Lung aeration was achieved at lower EIP and DP and higher Cdyn in the RM-group than in the PEEP10-group.
authors.affiliation: The Department of Paediatric Anaesthesia and Intensive Care, The Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden. angela.hanson@vgregion.se
authors.forename: Angela
authors.initials: A
authors.lastname: Hanson
authors.forename: Sylvia
authors.initials: S
authors.lastname: Göthberg
authors.forename: Krister
authors.initials: K
authors.lastname: Nilsson
authors.forename: Göran
authors.initials: G
authors.lastname: Hedenstierna
mesh_terms: D000818:Animals; D001784:Blood Gas Analysis; D018893:Bronchoalveolar Lavage; D008168:Lung / Q000000981:diagnostic imaging*; D023421:Models, Animal; D011175:Positive-Pressure Respiration; D012965:Sodium Chloride / Q000008:administration & dosage*; D013552:Swine; D013990:Tidal Volume; D013995:Time; D014057:Tomography, X-Ray Computed
chemical_list: D012965:Sodium Chloride