Published ahead of print on February 5, 2004, doi:10.1164/rccm.200305-614OC
Am. J. Respir. Crit. Care Med., Volume 169, Number 8, April 2004, 957-962
A more recent version of this article appeared on April 15, 2004
Submitted on May 15, 2003
Accepted on February 2, 2004
Pressure-Volume Curve Does Not Predict Steady-State Lung Volume In Canine Lavage Lung Injury
John M Downie1, Arthur J Nam1, and Brett A Simon1*
1 Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
* To whom correspondence should be addressed. E-mail: bsimon{at}jhmi.edu.
To better understand strategies for recruiting and maintaining lung volume in acute lung injury, we examined the relationships between steady-state lung volume and cumulative cyclic recruitment/derecruitment to volume history and the quasi-static pressure-volume curve in an animal saline lavage lung injury model. Small volume tidal pressure-volume loops performed after inflation from functional residual capacity demonstrated incremental, cyclic recruitment only if the peak pressure achieved exceeded Pflex on the pressure-volume curve, while loops performed after deflation from total lung capacity remained close to the envelope deflation curve. Recruitment continued to occur up to and beyond a peak inspiratory airway pressure of 40 cm H2O, as demonstrated by both the tidal loops and by computed tomography derived lung volume data. Tidal specific compliance was relatively constant across positive end-expiratory pressure levels after inflation from functional residual capacity but peaked at moderate positive end-expiratory pressure after deflation from total lung capacity, further demonstrating the effects of volume history and providing experimental validation of the recruitment models of Hickling (AJRCCM 163:69-78, 2001). These results support the interpretation of Pflex as pressure threshold for recruitment, but otherwise do not suggest a role for the pressure-volume curve in predicting steady-state lung volume.
Key words: Acute lung injury, computed tomography, mechanical ventilation, surfactant
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