Total Respiratory Pressure-Volume Curves in the Adult Respiratory Distress Syndrome

Matamis, D.; Lemaire, François; Harf, Alain; Brun‐Buisson, C.; Ansquer, Jean-Claude; Atlan, G

doi:10.1378/chest.86.1.58

Cited by 435 publications

(223 citation statements)

References 16 publications

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“…Indeed, a clear-cut inflexion was observed with early ARDS (chest X-ray: purely interstitial pattern). Accordingly in the setting of early ARDS (2−4 days), a large hysteresis is observed on the P-V curve but not in the setting of late ARDS [3,128] ( Figs 1 and 4 in [3]). By contrast, an absence of inflexion is often associated with PEEP inefficacy [3,127].…”

Section: ) P-v Curve: Inspiratory Vs Expiratory Inflexion Pointsmentioning

confidence: 99%

“…By contrast, an absence of inflexion is often associated with PEEP inefficacy [3,127]. Accordingly, no inflexion was observed with late ARDS (chest X-ray: alveolar pattern as opposed to fewer alveolar opacities and increased interstitial markings) [128] However, the critical opening pressure measured on the incremental (inspiratory) limb of the P-V curve is different from critical closing pressure measured on the decremental (expiratory) limb [3]. Investigators now agree: an inspiratory curve cannot be used to determine an expiratory variable [151,172].…”

Section: ) P-v Curve: Inspiratory Vs Expiratory Inflexion Pointsmentioning

confidence: 99%

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Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

Petitjeans

Pichot²,

Ghignone

et al. 2016

Anaesthesiol Intensive Ther

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Severe acute respiratory distress syndrome (ARDS, PaO 2 /FiO 2 < 100 on PEEP ≥ 5 cm H 2 O) is treated using controlled mechanical ventilation (CMV), recently combined with muscle relaxation for 48 h and prone positioning. While the amplitude of tidal volume appears set £ 6 mL kg -1 , the level of positive end-expiratory pressure (PEEP) remains controversial. This overview summarizes several salient points, namely: a) ARDS is an oxygenation defect: consolidation/difuse alveolar damage is reversed by PEEP and/or prone positioning, at least during the early phase of ARDS b) ARDS is a dynamic disease and partially iatrogenic. This implies that the management of the ventilator may be a life-saver by reducing the duration of mechanical ventilation, or detrimental by extending this duration, leading into critical care-acquired diseases. Indeed, a high PEEP (10−24 cm H 2 O) appears to be a life-saver in the context of early severe diffuse ARDS; c) tidal volume and plateau pressure cannot be identical for all patients; d) the only remaining rationale for CMV and muscle relaxation is to suppress patient-ventilator asynchrony and to lower VO 2 , during the acute cardio-ventilatory distress. Therefore, in early severe diffuse ARDS, this review argues for a combination of a high PEEP (preferably titrated on transpulmonary pressure) with spontaneous ventilation + pressure support (or newer modes of ventilation). However, conditionalities are stringent: upfront circulatory optimization, upright positioning, lowered VO 2 , lowered acidotic and hypercapnic drives, sedation without ventilatory depression and without lowered muscular tone. As these propositions require evidence-based demonstration, the accepted practice remains, in 2016, controlled mechanical ventilation, muscle relaxation, and prone position.

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Section: ) P-v Curve: Inspiratory Vs Expiratory Inflexion Pointsmentioning

confidence: 99%

Section: ) P-v Curve: Inspiratory Vs Expiratory Inflexion Pointsmentioning

confidence: 99%

Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

Petitjeans

Pichot²,

Ghignone

et al. 2016

Anaesthesiol Intensive Ther

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“…The P/V curve has been introduced to individualize V t and PEEP settings in patients with ARDS by Matamis et al in 1984(Matamis et al, 1984. In this concept, a lower inflection point (LIP) and an upper inflection point (UIP) are identified on the inflation limb of the P/V curve (Fig.…”

Section: Optimizing Peep With Lung Mechanicsmentioning

confidence: 99%

Optimizing Perioperative Ventilation Support with Adequate Settings of Positive End-Expiratory Pressure

Zhao¹,

Stahl²,

Müller-Lisse³

et al. 2012

Front Lines of Thoracic Surgery

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“…According to some authors [25][26][27], in ARDS patients without AIDS and PCP the inflection point is a common occurrence, though this might not be particularly frequent according to other studies [22,[28][29][30]. It has been suggested that the inflection is present in the earliest stage of ARDS, whereas later on, probably as a result of oedema resolution, the inflection disappears with or without increases or decreases in elastance, probably depending on the pattern of fibrosis development [26]. Our patients may represent a relatively late stage of ARDS, in spite of the fact that the duration of intubation was short (table 1).…”

Section: Static Inflation V-p Curvementioning

confidence: 99%

Lung and chest wall mechanics in patients with acquired immunodeficiency syndrome and severe Pneumocystis carinii pneumonia

et al. 1997

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Lung and chest wall mechanics in patients with acquired immunodeficiency syndrome and severe Pneumocystis carinii pneumonia. E. D 'Angelo, E. Calderini, F.M. Robatto, P. Puccio, J. Milic-Emili. ERS Journals Ltd 1997. ABSTRACT: The aim of this study was to assess the mechanical characteristics of the respiratory system in patients with acquired immune deficiency syndrome (AIDS) and acute respiratory distress syndrome (ARDS) caused by Pneumocystis carinii pneumonia (PCP).In 12 mechanically ventilated patients, total respiratory system mechanics was assessed using the technique of rapid airway occlusion during constant flow inflation, and was partitioned into lung and chest wall components using the oesophageal balloon technique. We measured interrupter resistance (Rint), which mainly reflects airway resistance, additional resistance (∆R) due to viscoelastic behaviour and time constant inequalities, and static elastance (Est). In addition, the static inflation volume-pressure (V-P) curve was assessed. In eight patients, computed tomography scans were performed within 2 days of the assessment of respiratory mechanics.Compared to values reported in the literature for normal subjects, Est and ∆R were markedly increased in AIDS patients with PCP, whilst Rint exhibited a relatively smaller increase. These changes, which involved only the lung and airways, were mainly due to the reduction of ventilated lung units, but additional factors were involved to cause independent modifications of lung stiffness, airway calibre, and viscoelastic properties. The changes in Rint, ∆R, and Est were similar to those observed in other studies on patients with ARDS of different aetiologies. At variance with common observations in the latter patients, none of the AIDS patients with PCP exhibited an inflection point on the static inflation V-P curve, suggesting little or no alveolar recruitment during lung inflation. This finding could be related to the distinctive histopathology of Pneumocystis carinii pneumonia. Indeed, computed tomography revealed homogeneous diffuse interstitial and alveolar infiltration rather than the dense, dependent opacities observed in other studies on acute respiratory distress syndrome of different aetiologies. Eur Respir J 1997; 10: 2343-2350 Pneumocystis carinii pneumonia (PCP) is the most frequent severe opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). It is held responsible for up to 85% of episodes of acute respiratory failure that occur in AIDS [1] and 80% of emergency admissions to intensive care units [2,3], with a reported mortality rate of 75-100% for patients requiring mechanical ventilation [4]. In a recent consensus conference [5], PCP was included, though not by unanimous decision, among the causes of acute respiratory distress syndrome (ARDS), once the following criteria are met: acute onset; arterial oxygen tension (Pa,O 2 )/inspiratory oxygen fraction (FI,O 2 ) <27 kPa (200 mmHg); bilateral infiltrates on chest radiographs; and no evidence of left atrial hyp...

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Total Respiratory Pressure-Volume Curves in the Adult Respiratory Distress Syndrome

Cited by 435 publications

References 16 publications

Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

Optimizing Perioperative Ventilation Support with Adequate Settings of Positive End-Expiratory Pressure

Lung and chest wall mechanics in patients with acquired immunodeficiency syndrome and severe Pneumocystis carinii pneumonia

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