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Am. J. Respir. Crit. Care Med., Volume 159, Number 4, April 1999, 1172-1178

Pressure-Volume Curves and Compliance in Acute Lung Injury
Evidence of Recruitment Above the Lower Inflection Point

BJÖRN JONSON, JEAN-CHRISTOPHE RICHARD, CHRISTIAN STRAUS, JORDI MANCEBO, FRANÇOIS LEMAIRE, and LAURENT BROCHARD

Medical Intensive Care Unit, INSERM U492, Hôpital Henri Mondor, AP-HP Paris XII University, Créteil, France; Department of Clinical Physiology, University Hospital of Lund, Lund, Sweden; and Hospital of Sant Pau, Barcelona, Spain

Measuring elastic pressure-volume (Pel-V) curves of the respiratory system and the volume recruited by a positive end-expiratory pressure (PEEP) allows one to study the pressure range over which recruitment occurs in acute lung injury (ALI), and to explain how recruitment affects the compliance. Pel-V curves were measured with the low flow inflation technique in 11 patients mechanically ventilated for ALI. Curve I was recorded during inflation from the volume attained after a prolonged expiration (6 s) at PEEP (9.0 ± 2.2 cm H2O), and Curve II after expiration to the elastic equilibrium volume at zero end-expiratory pressure (ZEEP). By using the end-expiratory volume of the breaths, the curves were aligned on a common volume axis to determine the effect of a single complete expiration. In each patient, Curve II (from ZEEP) was shifted toward lower volumes than Curve I. The volume shift, probably due to derecruitment, was 205 ± 100 ml at 15 cm H2O (p < 0.01) and 78 ± 93 ml at 30 cm H2O (p < 0.01); thus, during inflation from ZEEP, the volume deficit was successively regained over a pressure range up to at least 30 cm H2O. At any pressure, compliance was higher on the curve from ZEEP than from PEEP, by 10.0 ± 8.7 ml/cm H2O at 15 cm H2O (p < 0.01), and by 5.4 ± 5.5 at 30 cm H2O (p < 0.01). It is concluded that in ALI, a single expiration to ZEEP leads to lung collapse. High compliance during insufflation from ZEEP indicates that lung recruitment happens far above the lower inflection point of the Pel-V curve.




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