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Wiener klinische Wochenschrift
Erschienen in:

01.12.2012 | original article

Positive end-expiratory pressure lung recruitment: comparison between lower inflection point and ultrasound assessment

verfasst von: Bojan Rode, MD, Marinko Vučić, Mladen Širanović, Ana Horvat, Helena Krolo, Mijo Kelečić, Aleksandar Gopčević

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 23-24/2012

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Summary

Background

Maintenance of the open lung alveoli in the expiration on mechanical ventilation in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) remains challenging despite advances in lung imaging. The inspiratory lower inflection point (LIP) on the ventilator pressure–volume (P–V) curve estimates the required end-expiratory pressure for recruitment of alveolar consolidation. Alternatively, the end-expiratory pressure for recruitment of crater-like subpleural alveolar consolidation could be simply followed with ultrasound. These two methods for setting the ventilators positive end-expiratory pressure (PEEP) were compared.

Methods

The observational study in surgical/neurosurgical intensive care between October 2009 and November 2011 included 17 deeply sedated or relaxed patients. LIP was measured with continuous low-flow method, as a pressure in cmH2O. Expiratory levelling between lower border of subpleural consolidation and adjacent pleural line, which means lung recruitment, was followed with linear ultrasound probe. PEEP in cmH2O at which the levelling occurs was compared with LIP pressure.

Results

LIP pressure never exceeds the PEEP for recruitment of subpleural consolidations followed with ultrasound. A significant correlation (r = 0.839; p < 0.05) was found between two methods.

Conclusions

In this study, positive end-expiratory pressures for recruitment of subpleural consolidations followed by ultrasound always exceed the pressures measured with LIP. Respecting this, ultrasound method could be the guide for PEEP lung recruitment.
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Metadaten
Titel
Positive end-expiratory pressure lung recruitment: comparison between lower inflection point and ultrasound assessment
verfasst von
Bojan Rode, MD
Marinko Vučić
Mladen Širanović
Ana Horvat
Helena Krolo
Mijo Kelečić
Aleksandar Gopčević
Publikationsdatum
01.12.2012
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 23-24/2012
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-012-0303-1

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