Analysis of Dynamic Intratidal Compliance in a Lung Collapse Model

作者：Schumann Stefan^*; Vimlati Laszlo; Kawati Rafael; Guttmann Josef; Lichtwarck Aschoff Michael

来源：Anesthesiology, 2011, 114(5): 1111-1117.

DOI：10.1097/ALN.0b013e31820ad41b

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.

• 出版日期2011-5