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  • Title: Ability of dynamic airway pressure curve profile and elastance for positive end-expiratory pressure titration.
    Author: Carvalho AR, Spieth PM, Pelosi P, Vidal Melo MF, Koch T, Jandre FC, Giannella-Neto A, de Abreu MG.
    Journal: Intensive Care Med; 2008 Dec; 34(12):2291-9. PubMed ID: 18825365.
    Abstract:
    OBJECTIVE: To evaluate the ability of three indices derived from the airway pressure curve for titrating positive end-expiratory pressure (PEEP) to minimize mechanical stress while improving lung aeration assessed by computed tomography (CT). DESIGN: Prospective, experimental study. SETTING: University research facilities. SUBJECTS: Twelve pigs. INTERVENTIONS: Animals were anesthetized and mechanically ventilated with tidal volume of 7 ml kg(-1). In non-injured lungs (n = 6), PEEP was set at 16 cmH(2)O and stepwise decreased until zero. Acute lung injury was then induced either with oleic acid (n = 6) or surfactant depletion (n = 6). A recruitment maneuver was performed, the PEEP set at 26 cmH(2)O and decreased stepwise until zero. CT scans were obtained at end-expiratory and end-inspiratory pauses. The elastance of the respiratory system (Ers), the stress index and the percentage of volume-dependent elastance (%E (2)) were estimated. MEASUREMENTS AND MAIN RESULTS: In non-injured and injured lungs, the PEEP at which Ers was lowest (8-4 and 16-12 cmH(2)O, respectively) corresponded to the best compromise between recruitment/hyperinflation. In non-injured lungs, stress index and %E (2) correlated with tidal recruitment and hyperinflation. In injured lungs, stress index and %E (2) suggested overdistension at all PEEP levels, whereas the CT scans evidenced tidal recruitment and hyperinflation simultaneously. CONCLUSION: During ventilation with low tidal volumes, Ers seems to be useful for guiding PEEP titration in non-injured and injured lungs, while stress index and %E (2) are useful in non-injured lungs only. Our results suggest that Ers can be superior to the stress index and %E (2) to guide PEEP titration in focal loss of lung aeration.
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