Document Detail


Repeated generation of the pulmonary pressure-volume curve may lead to derecruitment in experimental lung injury.
MedLine Citation:
PMID:  15592813     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Measurements from the pulmonary pressure-volume (PV) curve have been proposed to adjust ventilator settings. We investigated the effects of repeated construction of an inflation PV curve implemented in a standard ventilator on recruitment or derecruitment in acutely injured lungs. DESIGN AND SETTING: Prospective experimental animal study in eight anesthetized and mechanically ventilated pigs. INTERVENTIONS: Acute lung injury was induced by lung lavage and animals were ventilated in volume controlled mode with PEEP 10 cmH(2)O. The PV curve was constructed five times repeatedly by constant pressure rise, after which ventilation with the preset PEEP was resumed immediately. Studies of hemodynamics, lung mechanics, blood gases and computed tomography were carried out before and after maneuvers. MEASUREMENTS AND RESULTS: Derecruitment was assessed as an increase in nonaerated lung volume (V(NON)), and V(PEEP) was the end-expiratory volume difference between PEEP and ZEEP. There was a significant decrease in PaO(2) from 90.4+/-33.3 to 70.9+/-36.3 mmHg and a rise in venous admixture from 47.8+/-12.7 to 59.1+/-16.6%. V(PEEP) was reduced from 244 to 202 ml. A corresponding decrease in normally aerated lung volume was observed, while regression analysis revealed increase in V(NON) depending on the amount of preexisting atelectasis. CONCLUSIONS: Repeated generation of the PV curve with a readily available tool resulted in worsened oxygenation. Derecruitment of the lungs occurred with loss of PEEP at the start of the maneuver, which could not be recovered by a maximum inflation pressure of 40 cmH(2)O. Repeated use of the investigated tool should be cautioned, and users should consider measures to preserve aerated lung volumes.
Authors:
Dietrich Henzler; Andreas Mahnken; Rolf Dembinski; Britta Waskowiak; Rolf Rossaint; Ralf Kuhlen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2004-12-09
Journal Detail:
Title:  Intensive care medicine     Volume:  31     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-02-10     Completed Date:  2005-07-14     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  302-10     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany. mail@d-henzler.de
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MeSH Terms
Descriptor/Qualifier:
Animals
Blood Gas Analysis
Bronchoalveolar Lavage
Female
Hemodynamics / physiology
Lung / radiography
Lung Injury*
Lung Volume Measurements
Positive-Pressure Respiration*
Pressure
Prospective Studies
Pulmonary Gas Exchange / physiology
Regression Analysis
Respiratory Mechanics / physiology*
Statistics, Nonparametric
Swine
Tomography, X-Ray Computed
Comments/Corrections
Comment In:
Intensive Care Med. 2005 Sep;31(9):1295; author reply 1296   [PMID:  15968534 ]

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