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Pressure–volume curve variations after a recruitment manoeuvre in acute lung injury/ARDS patients: implications for the understanding of the inflection points of the curve

Published online by Cambridge University Press:  19 April 2005

D. Pestaña ,
C. Hernández-Gancedo ,
C. Royo ,
H. Pérez-Chrzanowska  and
A. Criado
D. Pestaña
Affiliation:
Hospital Universitario La Paz, Servicio de Anestesia-Reanimación, Residencia General, Madrid, Spain
C. Hernández-Gancedo
Affiliation:
Hospital Universitario La Paz, Servicio de Anestesia-Reanimación, Residencia General, Madrid, Spain
C. Royo
Affiliation:
Hospital Universitario La Paz, Servicio de Anestesia-Reanimación, Residencia General, Madrid, Spain
H. Pérez-Chrzanowska
Affiliation:
Hospital Universitario La Paz, Servicio de Anestesia-Reanimación, Residencia General, Madrid, Spain
A. Criado
Affiliation:
Hospital Universitario La Paz, Servicio de Anestesia-Reanimación, Residencia General, Madrid, Spain
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Abstract

Summary

Background and objective: Although the pressure–volume (P–V) curve has been proposed in the management of mechanically ventilated patients, its interpretation remains unclear. Our aim has been to study the variations of the P–V curve after a recruitment manoeuvre (RM). Our hypothesis was that the lower inflection point (LIP) represents the presence of compressive atelectases, so it should not change after lung recruitment, while the upper inflection point (UIP) reflects reabsorptive atelectases, and an effective recruitment should result in changes at this level.

Methods: Two P–V curves (quasi-static method) separated by an RM (40 cmH2O, two consecutive manoeuvres) were plotted in 35 postoperative patients with criteria of acute lung injury/acute respiratory distress syndrome (ARDS). LIP, UIP and expiratory inflection point (EIP) were defined as the first point where the curve consistently starts to separate from the line.

Results: One to six measurements were obtained per patient (73 procedures). Neither the lower nor the EIPs varied significantly after the RM (P = 0.11 and 0.35, respectively). An UIP was observed in 18 curves (25%) before the RM and disappeared on nine occasions after the recruitment. Similar results were obtained when first measurements only were analysed, and when the cause (pulmonary vs. extrapulmonary), severity of lung injury or duration of mechanical ventilation at first measurement were studied.

Conclusions: An RM does not modify the LIP significantly, but induces the disappearance of the UIP in 50% of the cases in which this point is found.

Keywords

ACUTE RESPIRATORY DISTRESS SYNDROMEMECHANICAL VENTILATION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 3 , March 2005 , pp. 175 - 180
Copyright
2005 European Society of Anaesthesiology

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