Document Detail

Pressure-volume curves and compliance in acute lung injury: evidence of recruitment above the lower inflection point.
MedLine Citation:
PMID:  10194162     Owner:  NLM     Status:  MEDLINE    
Measuring elastic pressure-volume (Pel-V) curves of the respiratory system and the volume recruited by a positive end-expiratory pressure (PEEP) allows one to study the pressure range over which recruitment occurs in acute lung injury (ALI), and to explain how recruitment affects the compliance. Pel-V curves were measured with the low flow inflation technique in 11 patients mechanically ventilated for ALI. Curve I was recorded during inflation from the volume attained after a prolonged expiration (6 s) at PEEP (9.0 +/- 2.2 cm H2O), and Curve II after expiration to the elastic equilibrium volume at zero end-expiratory pressure (ZEEP). By using the end-expiratory volume of the breaths, the curves were aligned on a common volume axis to determine the effect of a single complete expiration. In each patient, Curve II (from ZEEP) was shifted toward lower volumes than Curve I. The volume shift, probably due to derecruitment, was 205 +/- 100 ml at 15 cm H2O (p < 0.01) and 78 +/- 93 ml at 30 cm H2O (p < 0.01); thus, during inflation from ZEEP, the volume deficit was successively regained over a pressure range up to at least 30 cm H2O. At any pressure, compliance was higher on the curve from ZEEP than from PEEP, by 10.0 +/- 8.7 ml/cm H2O at 15 cm H2O (p < 0.01), and by 5.4 +/- 5.5 at 30 cm H2O (p < 0.01). It is concluded that in ALI, a single expiration to ZEEP leads to lung collapse. High compliance during insufflation from ZEEP indicates that lung recruitment happens far above the lower inflection point of the Pel-V curve.
B Jonson; J C Richard; C Straus; J Mancebo; F Lemaire; L Brochard
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  159     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  1999 Apr 
Date Detail:
Created Date:  1999-05-17     Completed Date:  1999-05-17     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1172-8     Citation Subset:  AIM; IM    
Medical Intensive Care Unit, INSERM U492, Hôpital Henri Mondor, AP-HP Paris XII University, Créteil, France.
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MeSH Terms
Lung Compliance*
Lung Volume Measurements
Middle Aged
Positive-Pressure Respiration*
Respiratory Distress Syndrome, Adult / physiopathology*,  therapy
Respiratory Mechanics*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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