OBJECTIVE: To evaluate whether the shape of the airway pressure-time (Paw-t) curve during constant flow inflation corresponds to radiologic evidence of tidal recruitment or tidal hyperinflation in an experimental model of acute lung injury. DESIGN: Prospective randomized laboratory animal investigation. SETTING: Department of Clinical Physiology, University of Uppsala, Sweden. SUBJECTS: Anesthetized, paralyzed, and mechanically ventilated pigs. INTERVENTIONS: Acute lung injury was induced by lung lavage. During constant inspiratory flow, the Paw-t curve was fitted to a power equation: airway pressure =a x time + c, where coefficient b (stress index) describes the shape of the curve:b = 1, straight curve; b < 1, progressive increase in slope; and b > 1, progressive decrease in slope. Tidal volume (Vt) was 6 mL/kg, and positive end-expiratory pressure was set to obtain a b value between 0.9 and 1.1 before (b = 1) and after (b = 1 after recruiting maneuver) application of a recruiting maneuver. Positive end-expiratory pressure was decreased and Vt increased to obtain 0.9 >b > 0.8 and 0.8 >b > 0.6, whereas positive end-expiratory pressure and Vt were both increased to obtain 1.3 >b > 1.1 and 1.5 >b > 1.3. Experimental conditions sequence was random. MEASUREMENTS AND MAIN RESULTS: Pulmonary computed tomography was obtained during end-expiratory and end-inspiratory occlusions. Tidal recruitment was quantified as nonaerated (between -100 and +100 Hounsfield units) lung area at end-expiration minus end-inspiration. Tidal hyperinflation was quantified as hyperinflated (between -900 and -1000 Hounsfield units) lung area at end-inspiration minus end-expiration. Computed tomography images showed that tidal recruitment and tidal hyperinflation corresponded to b < 1 and b > 1, respectively. Stress index values and tidal recruitment and tidal hyperinflation values were significantly correlated (R =.917 and R =.911, p <.0001, respectively). CONCLUSIONS: Shape of the Paw-t curve detects tidal recruitment and tidal hyperinflation.

Airway pressure-time curve profile (stress index) detects tidal recruitment/hyperinflation in experimental acute lung injury

TERRAGNI, Pierpaolo;MASCIA, Luciana;FANELLI, VITO;RANIERI, Vito Marco
2004

Abstract

OBJECTIVE: To evaluate whether the shape of the airway pressure-time (Paw-t) curve during constant flow inflation corresponds to radiologic evidence of tidal recruitment or tidal hyperinflation in an experimental model of acute lung injury. DESIGN: Prospective randomized laboratory animal investigation. SETTING: Department of Clinical Physiology, University of Uppsala, Sweden. SUBJECTS: Anesthetized, paralyzed, and mechanically ventilated pigs. INTERVENTIONS: Acute lung injury was induced by lung lavage. During constant inspiratory flow, the Paw-t curve was fitted to a power equation: airway pressure =a x time + c, where coefficient b (stress index) describes the shape of the curve:b = 1, straight curve; b < 1, progressive increase in slope; and b > 1, progressive decrease in slope. Tidal volume (Vt) was 6 mL/kg, and positive end-expiratory pressure was set to obtain a b value between 0.9 and 1.1 before (b = 1) and after (b = 1 after recruiting maneuver) application of a recruiting maneuver. Positive end-expiratory pressure was decreased and Vt increased to obtain 0.9 >b > 0.8 and 0.8 >b > 0.6, whereas positive end-expiratory pressure and Vt were both increased to obtain 1.3 >b > 1.1 and 1.5 >b > 1.3. Experimental conditions sequence was random. MEASUREMENTS AND MAIN RESULTS: Pulmonary computed tomography was obtained during end-expiratory and end-inspiratory occlusions. Tidal recruitment was quantified as nonaerated (between -100 and +100 Hounsfield units) lung area at end-expiration minus end-inspiration. Tidal hyperinflation was quantified as hyperinflated (between -900 and -1000 Hounsfield units) lung area at end-inspiration minus end-expiration. Computed tomography images showed that tidal recruitment and tidal hyperinflation corresponded to b < 1 and b > 1, respectively. Stress index values and tidal recruitment and tidal hyperinflation values were significantly correlated (R =.917 and R =.911, p <.0001, respectively). CONCLUSIONS: Shape of the Paw-t curve detects tidal recruitment and tidal hyperinflation.
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GRASSO S; TERRAGNI P; MASCIA L; FANELLI V; QUINTEL M; HERRMANN P; HEDENSTIERNA G; SLUTSKY AS; RANIERI V
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2318/39348
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