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Analysis of Dynamic Intratidal Compliance in a Lung Collapse Model
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
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2011 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 114, no 5, 1111-1117 p.Article in journal (Refereed) Published
Abstract [en]

Background: For mechanical ventilation to be lung-protective, an accepted suggestion is to place the tidal volume (V-T) between the lower and upper inflection point of the airway pressure-volume relation. The drawback of this approach is, however, that the pressure-volume relation is assessed under quasistatic, no-flow conditions, which the lungs never experience during ventilation. Intratidal nonlinearity must be assessed under real (i.e., dynamic) conditions. With the dynamic gliding-SLICE technique that generates a high-resolution description of intratidal mechanics, the current study analyzed the profile of the compliance of the respiratory system (C-RS).

Methods: In 12 anesthetized piglets with lung collapse, the pressure-volume relation was acquired at different levels of positive end-expiratory pressure (PEEP: 0, 5, 10, and 15 cm H2O). Lung collapse was assessed by computed tomography and the intratidal course of C-RS using the gliding-SLICE method.

Results: Depending on PEEP, C-RS showed characteristic profiles. With low PEEP, C-RS increased up to 20% above the compliance at early inspiration, suggesting intratidal recruitment; whereas a profile of decreasing C-RS, signaling overdistension, occurred with V-T > 5 ml/kg and high PEEP levels. At the highest volume range, C-RS was up to 60% less than the maximum. With PEEP 10 cm H2O, C-RS was high and did not decrease before 5 ml/kg V-T was delivered.

Conclusions: The profile of dynamic C-RS reflects nonlinear intratidal mechanics of the respiratory system. The SLICE analysis has the potential to detect intratidal recruitment and overdistension. This might help in finding a combination of PEEP and V-T level that is protective from a lung-mechanics perspective.

Place, publisher, year, edition, pages
2011. Vol. 114, no 5, 1111-1117 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-153651DOI: 10.1097/ALN.0b013e31820ad41bISI: 000289980200015PubMedID: 21336098OAI: oai:DiVA.org:uu-153651DiVA: diva2:417388
Available from: 2011-05-17 Created: 2011-05-17 Last updated: 2017-12-11Bibliographically approved

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Vimlati, LaszloKawati, RafaelLichtwarck-Aschoff, Michael

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