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Regional tidal ventilation and compliance during a stepwise vital capacity manoeuvre.
MedLine Citation:
PMID:  20689920     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
PURPOSE: To determine whether, during mechanical ventilation, an optimal positive end-expiratory pressure (PEEP) can be identified by measurement of regional tidal volume and compliance [V (T(reg)), C (RS(reg))].
METHODS: Sixteen anaesthetized intubated neonatal piglets underwent a stepwise vital capacity manoeuvre performed during pressure control ventilation, with 5 cmH₂O PEEP increments to 25 cmH₂O, and decrements to 0 cmH₂O. Peak inflating pressure was 10 cmH₂O above PEEP throughout. The manoeuvre was performed in the normal lung, after repeated saline lavage and after surfactant therapy. Global V (T) and C (RS) were measured at the airway opening; V (T(reg)) and C (RS(reg)) were measured in the ventral, medial and dorsal lung using electrical impedance tomography (EIT).
RESULTS: Most uniform distribution of regional tidal ventilation was noted during PEEP decrements after lung recruitment, at varying PEEP levels. In the lavaged and surfactant-treated lung the PEEP optimal for ventilation distribution was also associated with highest mean V (T(reg)) [lavaged: 95 ± 9.3% of maximum, mean ± standard deviation (SD); surfactant-treated: 92 ± 17%] and global V (T) (96 ± 10%; 96 ± 15%). Regional C (RS) plots clearly demonstrated co-existent ventral overdistension and dorsal recruitment, particularly during PEEP increments; whereas during PEEP decrements, peak C (RS(reg)) values showed considerable interregional concordance [e.g. peak C (RS(reg)) in the lavaged left lung; ventral: 0.017 ± 0.0036; medial: 0.016 ± 0.0054; dorsal: 0.017 ± 0.0073 cmH₂O⁻¹; P = 0.98, analysis of variance (ANOVA)].
CONCLUSIONS: After lung recruitment, a PEEP level can be identified by EIT at which tidal ventilation is uniformly distributed, with associated concordance in compliance between lung regions. Bedside monitoring of regional tidal ventilation and compliance using EIT may thus aid in PEEP selection.
Authors:
Peter A Dargaville; Peter C Rimensberger; Inéz Frerichs
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-08-06
Journal Detail:
Title:  Intensive care medicine     Volume:  36     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1953-61     Citation Subset:  IM    
Affiliation:
Department of Paediatrics, Royal Hobart Hospital and University of Tasmania, Liverpool Street, Hobart, TAS, 7000, Australia. peter.dargaville@dhhs.tas.gov.au
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