Use of dynamic compliance for open lung positive end-expiratory pressure titration in an experimental study

Abstract

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.

ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure

“…Unfortunately none of these assumptions have never been verified in patients with ARDS [47]. Fourth: Several other methods have been proposed to set up an open lung approach [48,49]. Borges and coworkers showed that applying distending pressures up to 60 cmH 2 O could successfully recruit the lung in ARDS patients considered not responders to conventional lung distending pressures [50].…”

Should the ART trial change our practice?

“…Because PEEP is an expiratory setting, its level should be tailored after having recruited the lung, that is identifying the lowest PEEP level sustaining the recruited lung open. This is the theoretical basis for the decremental PEEP trial (9)(10)(11)(12).…”

Visualisation of Time-Variant Respiratory System Elastance in ARDS Models

“…It was found that E drs during increasing PEEP is significantly different to E drs during decreasing PEEP (p<0.005). Thus, this case shows the typical finding where PEEP should be titrated after the lung has been recruited [3][4][5]7]. However, a local minimum E drs was also found at 10 mbar during increasing PEEP titration, suggesting similar optimal PEEP settings.…”

“…Therefore, true minimal E drs can only be determined after a stabilisation period is provided at each PEEP level. Setting PEEP at minimum elastance theoretically benefits ventilation by maximising recruitment, reducing work of breathing and avoiding overdistension [3][4][5]9]. …”

“…E rs and R rs can be determined using multivariate regression or the integralbased method [7]. If R rs is assumed constant throughout a breath [3,4,7], E drs can be re-estimated using Equation (2) after R rs is estimated using Equation (1). (2) Patient-specific E drs is only analysed during the inspiration portion of the breathing cycle.…”