Document Detail

Positive end-expiratory pressure after a recruitment maneuver prevents both alveolar collapse and recruitment/derecruitment.
MedLine Citation:
PMID:  12615628     Owner:  NLM     Status:  MEDLINE    
We tested the hypothesis that collapsed alveoli opened by a recruitment maneuver would be unstable or recollapse without adequate positive end-expiratory pressure (PEEP) after recruitment. Surfactant deactivation was induced in pigs by Tween instillation. An in vivo microscope was placed on a lung area with significant atelectasis and the following parameters measured: (1) the number of alveoli per field and (2) alveolar stability (i.e., the change in alveolar size from peak inspiration to end expiration). We previously demonstrated that unstable alveoli cause lung injury. A recruitment maneuver (peak pressure = 45 cm H2O, PEEP = 35 cm H2O for 1 minute) was applied and alveolar number and stability were measured. Pigs were then separated into two groups with standard ventilation plus (1) 5 PEEP or (2) 10 PEEP and alveolar number and stability were again measured. The recruitment maneuver opened a significant number of alveoli, which were stable during the recruitment maneuver. Although both 5 PEEP and 10 PEEP after recruitment demonstrated improved oxygenation, alveoli ventilated with 10 PEEP were stable, whereas alveoli ventilated with 5 PEEP showed significant instability. This suggests recruitment followed by inadequate PEEP permits unstable alveoli and may result in ventilator-induced lung injury despite improved oxygenation.
Jeffrey M Halter; Jay M Steinberg; Henry J Schiller; Monica DaSilva; Louis A Gatto; Steve Landas; Gary F Nieman
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2003-02-25
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  167     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2003 Jun 
Date Detail:
Created Date:  2003-06-10     Completed Date:  2003-07-31     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1620-6     Citation Subset:  AIM; IM    
Department of Surgery, State University of New York Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, USA.
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MeSH Terms
Airway Resistance
Disease Models, Animal*
Lung Compliance
Microscopy, Video
Positive-Pressure Respiration / adverse effects,  methods*
Pulmonary Alveoli*
Pulmonary Atelectasis / chemically induced,  pathology,  physiopathology,  prevention & control*
Pulmonary Gas Exchange
Pulmonary Surfactants / antagonists & inhibitors*
Respiratory Distress Syndrome, Adult / chemically induced,  pathology,  physiopathology,  prevention & control*
Respiratory Mechanics
Surface-Active Agents
Reg. No./Substance:
0/Polysorbates; 0/Pulmonary Surfactants; 0/Surface-Active Agents
Comment In:
Am J Respir Crit Care Med. 2003 Jun 15;167(12):1585-6   [PMID:  12796049 ]

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