Document Detail


What has been learnt from P/V curves in patients with acute lung injury/acute respiratory distress syndrome.
MedLine Citation:
PMID:  12945997     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Mechanical impairment of the respiratory system was recognised soon after the description of acute respiratory distress syndrome. The analysis of the pressure/volume (P/V) curve of the respiratory system contributed a lot to the understanding of the pathophysiology of acute lung injury and formed the basis for lung protection. The lower and upper inflection points were regarded as points of interest to avoid cyclic derecruitment and overdistension and to optimise ventilatory settings. However, because of the heterogeneity of lung injury, reducing the mechanical properties of the whole respiratory system to a single curve is a schematic approach, which makes interpretation difficult. New data suggest that alveolar re-inflation occurs along the whole P/V curve that can, therefore, be considered as a recruitment curve. The lower inflection point has no relationship with alveolar opening and closure and does not indicate the positive end-expiratory pressure needed to prevent alveolar collapse. The shape of the P/V curve gives information about the extension and the homogeneity of lung injury, indicating the possibility of lung recruitment. The upper inflection point, classically seen as the beginning of overdistension, may also indicate the end of recruitment. The pressure/volume curve offers the unique opportunity of evaluating alveolar recruitment/derecruitment at the bedside that can be helpful for the identification of optimal ventilatory settings and makes the curve a valuable tool for the ventilatory management of acute lung injury.
Authors:
S M Maggiore; J C Richard; L Brochard
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The European respiratory journal. Supplement     Volume:  42     ISSN:  0904-1850     ISO Abbreviation:  Eur Respir J Suppl     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-08-29     Completed Date:  2003-12-24     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  8910681     Medline TA:  Eur Respir J Suppl     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  22s-26s     Citation Subset:  IM    
Affiliation:
Dept of Anaesthesiology and Intensive Care, Agostino Gemelli Hospital, Università Cattolica del Sacro Cuore, Rome, Italy. smmaggiore@libero.it
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Humans
Lung / physiopathology*
Lung Compliance
Lung Injury*
Lung Volume Measurements
Respiration, Artificial / methods
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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