Document Detail

The deflation limb of the pressure-volume relationship in infants during high-frequency ventilation.
MedLine Citation:
PMID:  16322649     Owner:  NLM     Status:  MEDLINE    
RATIONALE: The importance of applying high-frequency oscillatory ventilation with a high lung volume strategy in infants is well established. Currently, a lack of reliable methods for assessing lung volume limits clinicians' ability to achieve the optimum volume range. OBJECTIVES: To map the pressure-volume relationship of the lung during high-frequency oscillatory ventilation in infants, to determine at what point ventilation is being applied clinically, and to describe the relationship between airway pressure, lung volume, and oxygenation. METHODS: In 12 infants, a partial inflation limb and the deflation limb of the pressure-volume relationship were mapped using a quasi-static lung volume optimization maneuver. This involved stepwise airway pressure increments to total lung capacity, followed by decrements until the closing pressure of the lung was identified. MEASUREMENTS AND MAIN RESULTS: Lung volume and oxygen saturation were recorded at each airway pressure. Lung volume was measured using respiratory inductive plethysmography. A distinct deflation limb could be mapped in each infant. Overall, oxygenation and lung volume were improved by applying ventilation on the deflation limb. Maximal lung volume and oxygenation occurred on the deflation limb at a mean airway pressure of 3 and 5 cm H(2)O below the airway pressure approximating total lung capacity, respectively. CONCLUSIONS: Using current ventilation strategies, all infants were being ventilated near the inflation limb. It is possible to delineate the deflation limb in infants receiving high-frequency oscillatory ventilation; in doing so, greater lung volume and oxygenation can be achieved, often at lower airway pressures.
David G Tingay; John F Mills; Colin J Morley; Anastasia Pellicano; Peter A Dargaville
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2005-12-01
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  173     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-02-09     Completed Date:  2006-04-04     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:  414-20     Citation Subset:  AIM; IM    
Department of Neonatology, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia.
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MeSH Terms
High-Frequency Ventilation / methods*
Infant, Newborn
Lung / physiology*
Lung Volume Measurements
Comment In:
Am J Respir Crit Care Med. 2006 Jul 15;174(2):229; author reply 229-30   [PMID:  16822935 ]

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