title: Positive end-expiratory pressure increases strain in patients with ALI/ARDS.
abstract: OBJECTIVE
  The objective of this study was to assess the effects of positive end-expiratory pressure on recruitment, cyclic recruitment and derecruitment and strain in patients with acute lung injury and acute respiratory distress syndrome using lung computed tomography.
  
  
  METHODS
  This is an open, controlled, non-randomized interventional study of ten patients with acute lung injury and acute respiratory distress syndrome. Using computed tomography, single, basal slices of the lung were obtained during inspiratory and expiratory pauses at a tidal volume of 6 ml/kg and a positive end-expiratory pressure of 5, 10, 15 and 20 cmH2O. The densities of the lung parenchyma were measured in Hounsfield units. The values for positive end-expiratory pressure-induced recruitment, cyclic recruitment and derecruitment and strain were then calculated.
  
  
  RESULTS
  Increasing levels of positive end-expiratory pressure were correlated with increased recruitment and global strain (p < 0.01), which was significantly correlated with plateau pressure (r² = 0.97, p < 0.01). In addition, increasing levels of positive end-expiratory pressure systematically increased strain along the sternovertebral axis.
  
  
  CONCLUSIONS
  While strain is an adverse effect of positive end-expiratory pressure, the decision use positive end-expiratory pressure with any patient should be balanced against the potential benefits of recruitment. Due to the small number of patients in this study, the present data should be treated as hypothesis generating and is not intended to limit the clinical application of a high level of positive end-expiratory pressure in patients with severe hypoxemia.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Bugedo
authors.forename: Alejandro
authors.initials: A
authors.lastname: Bruhn
authors.forename: Tomás
authors.initials: T
authors.lastname: Regueira
authors.forename: Carlos
authors.initials: C
authors.lastname: Romero
authors.forename: Jaime
authors.initials: J
authors.lastname: Retamal
authors.forename: Glenn
authors.initials: G
authors.lastname: Hernández