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Use of dynamic compliance for open lung positive end-expiratory pressure titration in an experimental study.
Crit Care Med. 2007 Jan; 35(1):214-21.CC

Abstract

OBJECTIVE

We tested whether the continuous monitoring of dynamic compliance could become a useful bedside tool for detecting the beginning of collapse of a fully recruited lung.

DESIGN

Prospective laboratory animal investigation.

SETTING

Clinical physiology research laboratory, University of Uppsala, Sweden.

SUBJECTS

Eight pigs submitted to repeated lung lavages.

INTERVENTIONS

Lung recruitment maneuver, the effect of which was confirmed by predefined oxygenation, lung mechanics, and computed tomography scan criteria, was followed by a positive end-expiratory pressure (PEEP) reduction trial in a volume control mode with a tidal volume of 6 mL/kg. Every 10 mins, PEEP was reduced in steps of 2 cm H2O starting from 24 cm H2O. During PEEP reduction, lung collapse was defined by the maximum dynamic compliance value after which a first measurable decrease occurred. Open lung PEEP according to dynamic compliance was then defined as the level of PEEP before the point of collapse. This value was compared with oxygenation (Pao2) and CT scans.

MEASUREMENTS AND MAIN RESULTS

Pao2 and dynamic compliance were monitored continuously, whereas computed tomography scans were obtained at the end of each pressure step. Collapse defined by dynamic compliance occurred at a PEEP of 14 cm H2O. This level coincided with the oxygenation-based collapse point when also shunt started to increase and occurred one step before the percentage of nonaerated tissue on the computed tomography exceeded 5%. Open lung PEEP was thus at 16 cm H2O, the level at which oxygenation and computed tomography scan confirmed a fully open, not yet collapsed lung condition.

CONCLUSIONS

In this experimental model, the continuous monitoring of dynamic compliance identified the beginning of collapse after lung recruitment. These findings were confirmed by oxygenation and computed tomography scans. This method might become a valuable bedside tool for identifying the level of PEEP that prevents end-expiratory collapse.

Authors+Show Affiliations

Intensive Care Unit, Fundación Jiménez Díaz-Capio, Avenida de los Reyes Católicos 2, 28010 Madrid, Spain. fsuarez@fjd.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Validation Study

Language

eng

PubMed ID

17110872

Citation

Suarez-Sipmann, Fernando, et al. "Use of Dynamic Compliance for Open Lung Positive End-expiratory Pressure Titration in an Experimental Study." Critical Care Medicine, vol. 35, no. 1, 2007, pp. 214-21.
Suarez-Sipmann F, Böhm SH, Tusman G, et al. Use of dynamic compliance for open lung positive end-expiratory pressure titration in an experimental study. Crit Care Med. 2007;35(1):214-21.
Suarez-Sipmann, F., Böhm, S. H., Tusman, G., Pesch, T., Thamm, O., Reissmann, H., Reske, A., Magnusson, A., & Hedenstierna, G. (2007). Use of dynamic compliance for open lung positive end-expiratory pressure titration in an experimental study. Critical Care Medicine, 35(1), 214-21.
Suarez-Sipmann F, et al. Use of Dynamic Compliance for Open Lung Positive End-expiratory Pressure Titration in an Experimental Study. Crit Care Med. 2007;35(1):214-21. PubMed PMID: 17110872.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of dynamic compliance for open lung positive end-expiratory pressure titration in an experimental study. AU - Suarez-Sipmann,Fernando, AU - Böhm,Stephan H, AU - Tusman,Gerardo, AU - Pesch,Tanja, AU - Thamm,Oliver, AU - Reissmann,Hajo, AU - Reske,Andreas, AU - Magnusson,Anders, AU - Hedenstierna,Göran, PY - 2006/11/18/pubmed PY - 2007/1/20/medline PY - 2006/11/18/entrez SP - 214 EP - 21 JF - Critical care medicine JO - Crit. Care Med. VL - 35 IS - 1 N2 - OBJECTIVE: We tested whether the continuous monitoring of dynamic compliance could become a useful bedside tool for detecting the beginning of collapse of a fully recruited lung. DESIGN: Prospective laboratory animal investigation. SETTING: Clinical physiology research laboratory, University of Uppsala, Sweden. SUBJECTS: Eight pigs submitted to repeated lung lavages. INTERVENTIONS: Lung recruitment maneuver, the effect of which was confirmed by predefined oxygenation, lung mechanics, and computed tomography scan criteria, was followed by a positive end-expiratory pressure (PEEP) reduction trial in a volume control mode with a tidal volume of 6 mL/kg. Every 10 mins, PEEP was reduced in steps of 2 cm H2O starting from 24 cm H2O. During PEEP reduction, lung collapse was defined by the maximum dynamic compliance value after which a first measurable decrease occurred. Open lung PEEP according to dynamic compliance was then defined as the level of PEEP before the point of collapse. This value was compared with oxygenation (Pao2) and CT scans. MEASUREMENTS AND MAIN RESULTS: Pao2 and dynamic compliance were monitored continuously, whereas computed tomography scans were obtained at the end of each pressure step. Collapse defined by dynamic compliance occurred at a PEEP of 14 cm H2O. This level coincided with the oxygenation-based collapse point when also shunt started to increase and occurred one step before the percentage of nonaerated tissue on the computed tomography exceeded 5%. Open lung PEEP was thus at 16 cm H2O, the level at which oxygenation and computed tomography scan confirmed a fully open, not yet collapsed lung condition. CONCLUSIONS: In this experimental model, the continuous monitoring of dynamic compliance identified the beginning of collapse after lung recruitment. These findings were confirmed by oxygenation and computed tomography scans. This method might become a valuable bedside tool for identifying the level of PEEP that prevents end-expiratory collapse. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/17110872/Use_of_dynamic_compliance_for_open_lung_positive_end_expiratory_pressure_titration_in_an_experimental_study_ L2 - https://dx.doi.org/10.1097/01.CCM.0000251131.40301.E2 DB - PRIME DP - Unbound Medicine ER -