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.

This article has been cited by other articles:

				D. Talmor, T. Sarge, A. Malhotra, C. R. O'Donnell, R. Ritz, A. Lisbon, V. Novack, and S. H. Loring Mechanical Ventilation Guided by Esophageal Pressure in Acute Lung Injury N. Engl. J. Med., November 13, 2008; 359(20): 2095 - 2104. [Abstract] [Full Text] [PDF]

				A. Mercat, J.-C. Richard, and L. Brochard Ventilation Strategies for Acute Lung Injury and Acute Respiratory Distress Syndrome--Reply JAMA, July 2, 2008; 300(1): 41 - 42. [Full Text] [PDF]

				S. Maisch, H. Reissmann, B. Fuellekrug, D. Weismann, T. Rutkowski, G. Tusman, and S. H. Bohm Compliance and Dead Space Fraction Indicate an Optimal Level of Positive End-Expiratory Pressure After Recruitment in Anesthetized Patients Anesth. Analg., January 1, 2008; 106(1): 175 - 181. [Abstract] [Full Text] [PDF]

				D. Henzler, N. Hochhausen, R. Dembinski, S. Orfao, R. Rossaint, and R. Kuhlen Parameters Derived from the Pulmonary Pressure Volume Curve, but Not the Pressure Time Curve, Indicate Recruitment in Experimental Lung Injury Anesth. Analg., October 1, 2007; 105(4): 1072 - 1078. [Abstract] [Full Text] [PDF]

				T. Luecke, J. P. Meinhardt, P. Herrmann, A. Weiss, M. Quintel, and P. Pelosi Oleic Acid vs Saline Solution Lung Lavage-Induced Acute Lung Injury: Effects on Lung Morphology, Pressure-Volume Relationships, and Response to Positive End-Expiratory Pressure. Chest, August 1, 2006; 130(2): 392 - 401. [Abstract] [Full Text] [PDF]

				P. D. Macnaughton New ventilators for the ICU--usefulness of lung performance reporting Br. J. Anaesth., July 1, 2006; 97(1): 57 - 63. [Abstract] [Full Text] [PDF]

				F. Petak, W. Habre, B. Babik, J. Tolnai, and Z. Hantos Crackle-sound recording to monitor airway closure and recruitment in ventilated pigs. Eur. Respir. J., April 1, 2006; 27(4): 808 - 816. [Abstract] [Full Text] [PDF]

				G. Mols, H.-J. Priebe, and J. Guttmann Alveolar recruitment in acute lung injury Br. J. Anaesth., February 1, 2006; 96(2): 156 - 166. [Abstract] [Full Text] [PDF]

				M. David, J. Karmrodt, C. Bletz, S. David, A. Herweling, H.-U. Kauczor, and K. Markstaller Analysis of Atelectasis, Ventilated, and Hyperinflated Lung During Mechanical Ventilation by Dynamic CT Chest, November 1, 2005; 128(5): 3757 - 3770. [Abstract] [Full Text] [PDF]

				G. B. Allen, L. A. Pavone, J. D. DiRocco, J. H. T. Bates, and G. F. Nieman Pulmonary impedance and alveolar instability during injurious ventilation in rats J Appl Physiol, August 1, 2005; 99(2): 723 - 730. [Abstract] [Full Text] [PDF]

				P. Michelet, A. Roch, D. Brousse, X.-B. D'Journo, F. Bregeon, D. Lambert, G. Perrin, L. Papazian, P. Thomas, J.-P. Carpentier, et al. Effects of PEEP on oxygenation and respiratory mechanics during one-lung ventilation Br. J. Anaesth., August 1, 2005; 95(2): 267 - 273. [Abstract] [Full Text] [PDF]

				S. D. Mentzelopoulos, C. Roussos, and S. G. Zakynthinos Prone position reduces lung stress and strain in severe acute respiratory distress syndrome Eur. Respir. J., March 1, 2005; 25(3): 534 - 544. [Abstract] [Full Text] [PDF]

				S. D. Mentzelopoulos, C. Roussos, and S. G. Zakynthinos Prone position improves expiratory airway mechanics in severe chronic bronchitis Eur. Respir. J., February 1, 2005; 25(2): 259 - 268. [Abstract] [Full Text] [PDF]

				G. M. Albaiceta, F. Taboada, D. Parra, L. H. Luyando, J. Calvo, R. Menendez, and J. Otero Tomographic Study of the Inflection Points of the Pressure-Volume Curve in Acute Lung Injury Am. J. Respir. Crit. Care Med., November 15, 2004; 170(10): 1066 - 1072. [Abstract] [Full Text] [PDF]

				Z. Hantos, J. Tolnai, T. Asztalos, F. Petak, A. Adamicza, A. M. Alencar, A. Majumdar, and B. Suki Acoustic evidence of airway opening during recruitment in excised dog lungs J Appl Physiol, August 1, 2004; 97(2): 592 - 598. [Abstract] [Full Text] [PDF]

				P. Prodhan and N. Noviski Pediatric Acute Hypoxemic Respiratory Failure: Management of Oxygenation J Intensive Care Med, May 1, 2004; 19(3): 140 - 153. [Abstract] [PDF]

				J. M. Downie, A. J. Nam, and B. A. Simon Pressure-Volume Curve Does Not Predict Steady-State Lung Volume in Canine Lavage Lung Injury Am. J. Respir. Crit. Care Med., April 15, 2004; 169(8): 957 - 962. [Abstract] [Full Text] [PDF]

				G. Allen and J. H. T. Bates Dynamic mechanical consequences of deep inflation in mice depend on type and degree of lung injury J Appl Physiol, January 1, 2004; 96(1): 293 - 300. [Abstract] [Full Text] [PDF]

				C. Pereira, J. Bohe, S. Rosselli, E. Combourieu, C. Pommier, J.-P. Perdrix, J.-C. Richard, M. Badet, S. Gaillard, F. Philit, et al. Sigmoidal equation for lung and chest wall volume-pressure curves in acute respiratory failure J Appl Physiol, November 1, 2003; 95(5): 2064 - 2071. [Abstract] [Full Text] [PDF]

				J-D. Ricard, D. Dreyfuss, and G. Saumon Ventilator-induced lung injury Eur. Respir. J., August 1, 2003; 22(42_suppl): 2s - 9s. [Abstract] [Full Text] [PDF]

				P.P. Terragni, G.L. Rosboch, A. Lisi, A.G. Viale, and V.M. Ranieri How respiratory system mechanics may help in minimising ventilator-induced lung injury in ARDS patients Eur. Respir. J., August 1, 2003; 22(42_suppl): 15s - 21s. [Abstract] [Full Text] [PDF]

				S.M. Maggiore, J-C. Richard, and L. Brochard What has been learnt from P/V curves in patients with acute lung injury/acute respiratory distress syndrome Eur. Respir. J., August 1, 2003; 22(42_suppl): 22s - 26s. [Abstract] [Full Text] [PDF]

				J-J. Rouby, Q. Lu, and S. Vieira Pressure/volume curves and lung computed tomography in acute respiratory distress syndrome Eur. Respir. J., August 1, 2003; 22(42_suppl): 27s - 36s. [Abstract] [Full Text] [PDF]

				I. de Chazal and R. D. Hubmayr Novel aspects of pulmonary mechanics in intensive care Br. J. Anaesth., July 1, 2003; 91(1): 81 - 91. [Full Text] [PDF]

				S. M. Maggiore, F. Lellouche, J. Pigeot, S. Taille, N. Deye, X. Durrmeyer, J.-C. Richard, J. Mancebo, F. Lemaire, and L. Brochard Prevention of Endotracheal Suctioning-induced Alveolar Derecruitment in Acute Lung Injury Am. J. Respir. Crit. Care Med., May 1, 2003; 167(9): 1215 - 1224. [Abstract] [Full Text] [PDF]

				C. Edibam, A. J. Rutten, D. V. Collins, and A. D. Bersten Effect of Inspiratory Flow Pattern and Inspiratory to Expiratory Ratio on Nonlinear Elastic Behavior in Patients with Acute Lung Injury Am. J. Respir. Crit. Care Med., March 1, 2003; 167(5): 702 - 707. [Abstract] [Full Text] [PDF]

				J. E. Baumgardner, K. Markstaller, B. Pfeiffer, M. Doebrich, and C. M. Otto Effects of Respiratory Rate, Plateau Pressure, and Positive End-Expiratory Pressure on PaO2 Oscillations after Saline Lavage Am. J. Respir. Crit. Care Med., December 15, 2002; 166(12): 1556 - 1562. [Abstract] [Full Text] [PDF]

				G. Allen, L. K. A. Lundblad, P. Parsons, and J. H. T. Bates Transient mechanical benefits of a deep inflation in the injured mouse lung J Appl Physiol, November 1, 2002; 93(5): 1709 - 1715. [Abstract] [Full Text] [PDF]

				F. Jardin Alveolar derecruitment at decremental positive end-expiratory pressure levels in acute lung injury Am. J. Respir. Crit. Care Med., October 15, 2002; 166(8): 1141 - 1141. [Full Text] [PDF]

				J. H. T. Bates and C. G. Irvin Time dependence of recruitment and derecruitment in the lung: a theoretical model J Appl Physiol, August 1, 2002; 93(2): 705 - 713. [Abstract] [Full Text] [PDF]

				E. Kondili, G. Prinianakis, H. Athanasakis, and D. Georgopoulos Lung emptying in patients with acute respiratory distress syndrome: effects of positive end-expiratory pressure Eur. Respir. J., May 1, 2002; 19(5): 811 - 819. [Abstract] [Full Text] [PDF]

				W. L. Lee, T. E. Stewart, R. MacDonald, S. Lapinsky, D. Banayan, D. Hallett, and S. Mehta Safety of Pressure-Volume Curve Measurement in Acute Lung Injury and ARDS Using a Syringe Technique* Chest, May 1, 2002; 121(5): 1595 - 1601. [Abstract] [Full Text] [PDF]

				A. Vieillard-Baron, S. Prin, J.-M. Schmitt, R. Augarde, B. Page, A. Beauchet, and F. Jardin Pressure-Volume Curves in Acute Respiratory Distress Syndrome . Clinical Demonstration of the Influence of Expiratory Flow Limitation on the Initial Slope Am. J. Respir. Crit. Care Med., April 15, 2002; 165(8): 1107 - 1112. [Abstract] [Full Text] [PDF]

				J. J. ROUBY, Q. LU, and I. GOLDSTEIN Selecting the Right Level of Positive End-Expiratory Pressure in Patients with Acute Respiratory Distress Syndrome Am. J. Respir. Crit. Care Med., April 15, 2002; 165(8): 1182 - 1186. [Full Text] [PDF]

				A. VILLAGRA, A. OCHAGAVIA, S. VATUA, G. MURIAS, M. DEL MAR FERNANDEZ, J. L. AGUILAR, R. FERNANDEZ, and L. BLANCH Recruitment Maneuvers during Lung Protective Ventilation in Acute Respiratory Distress Syndrome Am. J. Respir. Crit. Care Med., January 15, 2002; 165(2): 165 - 170. [Abstract] [Full Text] [PDF]

				L. GATTINONI, P. CAIRONI, P. PELOSI, and L. R. GOODMAN What Has Computed Tomography Taught Us about the Acute Respiratory Distress Syndrome? Am. J. Respir. Crit. Care Med., November 1, 2001; 164(9): 1701 - 1711. [Full Text] [PDF]

				M. MANCINI, E. ZAVALA, J. MANCEBO, C. FERNANDEZ, J. A. BARBERA, A. ROSSI, J. ROCA, and R. RODRIGUEZ-ROISIN Mechanisms of Pulmonary Gas Exchange Improvement during a Protective Ventilatory Strategy in Acute Respiratory Distress Syndrome Am. J. Respir. Crit. Care Med., October 15, 2001; 164(8): 1448 - 1453. [Abstract] [Full Text] [PDF]

				M. TAKEUCHI, K. A. SEDEEK, G. P. P. SCHETTINO, K. SUCHODOLSKI, and R. M. KACMAREK Peak Pressure During Volume History and Pressure-Volume Curve Measurement Affects Analysis Am. J. Respir. Crit. Care Med., October 1, 2001; 164(7): 1225 - 1230. [Abstract] [Full Text] [PDF]

				S. M. MAGGIORE, B. JONSON, J.-C. RICHARD, S. JABER, F. LEMAIRE, and L. BROCHARD Alveolar Derecruitment at Decremental Positive End-Expiratory Pressure Levels in Acute Lung Injury . Comparison with the Lower Inflection Point, Oxygenation, and Compliance Am. J. Respir. Crit. Care Med., September 1, 2001; 164(5): 795 - 801. [Abstract] [Full Text] [PDF]

				L. MARTIN-LEFEVRE, J.-D. RICARD, E. ROUPIE, D. DREYFUSS, and G. SAUMON Significance of the Changes in the Respiratory System Pressure-Volume Curve during Acute Lung Injury in Rats Am. J. Respir. Crit. Care Med., August 15, 2001; 164(4): 627 - 632. [Abstract] [Full Text] [PDF]

				G. RIALP, A. J. BETBESE, M. PEREZ-MARQUEZ, and J. MANCEBO Short-term Effects of Inhaled Nitric Oxide and Prone Position in Pulmonary and Extrapulmonary Acute Respiratory Distress Syndrome Am. J. Respir. Crit. Care Med., July 15, 2001; 164(2): 243 - 249. [Abstract] [Full Text] [PDF]

				M. Mergoni, A. Volpi, C. Bricchi, and A. Rossi Lower inflection point and recruitment with PEEP in ventilated patients with acute respiratory failure J Appl Physiol, July 1, 2001; 91(1): 441 - 450. [Abstract] [Full Text] [PDF]

				S. CROTTI, D. MASCHERONI, P. CAIRONI, P. PELOSI, G. RONZONI, M. MONDINO, J. J. MARINI, and L. GATTINONI Recruitment and Derecruitment during Acute Respiratory Failure . A Clinical Study Am. J. Respir. Crit. Care Med., July 1, 2001; 164(1): 131 - 140. [Abstract] [Full Text] [PDF]

				J.-C. RICHARD, S. M. MAGGIORE, B. JONSON, J. MANCEBO, F. LEMAIRE, and L. BROCHARD Influence of Tidal Volume on Alveolar Recruitment . Respective Role of PEEP and a Recruitment Maneuver Am. J. Respir. Crit. Care Med., June 1, 2001; 163(7): 1609 - 1613. [Abstract] [Full Text] [PDF]

				L. Brochard Watching What PEEP Really Does Am. J. Respir. Crit. Care Med., May 1, 2001; 163(6): 1291 - 1292. [Full Text]

				E. De Robertis, J.M. Liu, S. Blomquist, P.L. Dahm, J. Thorne, and B. Jonson Elastic properties of the lung and the chest wall in young and adult healthy pigs Eur. Respir. J., April 1, 2001; 17(4): 703 - 711. [Abstract] [Full Text] [PDF]

				M. LICHTWARCK-ASCHOFF, G. MOLS, A. J. HEDLUND, V. KESSLER, A. M. MARKSTRÖM, J. GUTTMANN, G. HEDENSTIERNA, and U. H. SJÖSTRAND Compliance Is Nonlinear over Tidal Volume Irrespective of Positive End-Expiratory Pressure Level in Surfactant-Depleted Piglets Am. J. Respir. Crit. Care Med., December 1, 2000; 162(6): 2125 - 2133. [Abstract] [Full Text]

				M. Lichtwarck-Aschoff, V. Kessler, U. H. Sjostrand, A. Hedlund, G. Mols, S. Rubertsson, A. M. Markstrom, and J. Guttmann Static versus dynamic respiratory mechanics for setting the ventilator Br. J. Anaesth., October 1, 2000; 85(4): 577 - 586. [Abstract] [Full Text] [PDF]

				J. A. Krishnan and R. G. Brower High-Frequency Ventilation for Acute Lung Injury and ARDS Chest, September 1, 2000; 118(3): 795 - 807. [Abstract] [Full Text] [PDF]

				Y. FUJINO, S. GODDON, J.-D. CHICHE, J. HROMI, and R. M. KACMAREK Partial Liquid Ventilation Ventilates Better than Gas Ventilation Am. J. Respir. Crit. Care Med., August 1, 2000; 162(2): 650 - 657. [Abstract] [Full Text] [PDF]

				V. NÈVE, E. D. de la ROQUE, F. LECLERC, S. LETEURTRE, A. DORKENOO, A. SADIK, R. CREMER, and R. LOGIER Ventilator-induced Overdistension in Children . Dynamic versus Low-flow Inflation Volume-Pressure Curves Am. J. Respir. Crit. Care Med., July 1, 2000; 162(1): 139 - 147. [Abstract] [Full Text]

				A. KOUTSOUKOU, A. ARMAGANIDIS, C. STAVRAKAKI-KALLERGI, T. VASSILAKOPOULOS, A. LYMBERIS, C. ROUSSOS, and J. MILIC-EMILI Expiratory Flow Limitation and Intrinsic Positive End-Expiratory Pressure at Zero Positive End-Expiratory Pressure in Patients with Adult Respiratory Distress Syndrome Am. J. Respir. Crit. Care Med., May 1, 2000; 161(5): 1590 - 1596. [Abstract] [Full Text]