title: Predicting the response of the injured lung to the mechanical breath profile.
abstract: Mechanical ventilation is a crucial component of the supportive care provided to patients with acute respiratory distress syndrome. Current practice stipulates the use of a low tidal volume (VT) of 6 ml/kg ideal body weight, the presumptive notion being that this limits overdistension of the tissues and thus reduces volutrauma. We have recently found, however, that airway pressure release ventilation (APRV) is efficacious at preventing ventilator-induced lung injury, yet APRV has a very different mechanical breath profile compared with conventional low-VT ventilation. To gain insight into the relative merits of these two ventilation modes, we measured lung mechanics and derecruitability in rats before and following Tween lavage. We fit to these lung mechanics measurements a computational model of the lung that accounts for both the degree of tissue distension of the open lung and the amount of lung derecruitment that takes place as a function of time. Using this model, we predicted how tissue distension, open lung fraction, and intratidal recruitment vary as a function of ventilator settings both for conventional low-VT ventilation and for APRV. Our predictions indicate that APRV is more effective at recruiting the lung than low-VT ventilation, but without causing more overdistension of the tissues. On the other hand, low-VT ventilation generally produces less intratidal recruitment than APRV. Predictions such as these may be useful for deciding on the relative benefits of different ventilation modes and thus may serve as a means for determining how to ventilate a given lung in the least injurious fashion.
authors: Vermont Lung Center, University of Vermont College of Medicine, Burlington, Vermont;
authors: Bradford J
authors: BJ
authors: Smith
authors: Vermont Lung Center, University of Vermont College of Medicine, Burlington, Vermont;
authors: Lennart K A
authors: LK
authors: Lundblad
authors: Department of Surgery, State University of New York Upstate Medical University, Syracuse, New York; and.
authors: Michaela
authors: M
authors: Kollisch-Singule
authors: Department of Surgery, State University of New York Upstate Medical University, Syracuse, New York; and.
authors: Joshua
authors: J
authors: Satalin
authors: Department of Surgery, State University of New York Upstate Medical University, Syracuse, New York; and.
authors: Gary
authors: G
authors: Nieman
authors: R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland.
authors: Nader
authors: N
authors: Habashi
authors: Vermont Lung Center, University of Vermont College of Medicine, Burlington, Vermont; jason.h.bates@uvm.edu.
authors: Jason H T
authors: JH
authors: Bates
mesh_terms: D000818:Animals; D003198:Computer Simulation; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D055119:Elastic Modulus; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D055370:Lung Injury / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008954:Models, Biological; D011379:Prognosis; D051381:Rats; D017207:Rats, Sprague-Dawley; D020127:Recovery of Function; D015203:Reproducibility of Results; D015656:Respiratory Mechanics; D012680:Sensitivity and Specificity; D013718:Tensile Strength; D013813:Therapy, Computer-Assisted / Q000379:methods; D013990:Tidal Volume; D016896:Treatment Outcome
keywords: ARDS; lung injury; mechanical ventilation; predictive computational model
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