Volume-dependent compliance in ARDS: proposal of a new diagnostic concept

Mols, Georg; Brandes, Iris; Kessler, Volker; Lichtwarck-Aschoff, Michael; Loop, Torsten; Geiger, K.; Guttmann, J.

doi:10.1007/s001340051016

Cited by 74 publications

(68 citation statements)

References 41 publications

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“…The nonlinear behavior of the P/V relationship over a commonly used VT has been described for inflation compliance in surfacant-depleted animals [25]. Furthermore, in patients with acute lung injury [26] and in surfactantdepleted isolated rabbit lungs [27] respiratory system compliance, calculated during uninterrupted ventilation using multilinear regression analysis, has also been shown to be V dependent. To the best of the authors9 knowledge, this study is the first showing that in ARDS patients ventilated with commonly used VT, nonlinear P/V is also present during deflation.…”

Section: Discussionmentioning

confidence: 99%

Lung emptying in patients with acute respiratory distress syndrome: effects of positive end-expiratory pressure

Kondili¹,

Prinianakis²,

Athanasakis³

et al. 2002

European Respiratory Journal

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The pattern of lung emptying was studied in 10 mechanically-ventilated patients with acute respiratory distress syndrome.At four levels of positive end-expiratory pressure (PEEP) (0, 5, 10 and 15 cmH 2 O) tracheal (Ptr) and airway pressures (Paw), flow (V9) and volume (V) were continuously recorded. Tidal volume was set between 0.5-0.6 L and V9/V curves during passive expiration were obtained. Expired volume was divided into five equal volume slices and the time constant (te) and effective deflation compliance (Crs eff ) of each slice was calculated by regression analysis of V/V9 and postocclusion V/Ptr relationships, respectively. In each slice, the presence or absence of flow limitation was examined by comparing V9/V curves with and without decreasing Paw. For a given slice, total expiratory resistance (Rtot) (consisting of the respiratory system (Rrs), endotracheal tube (Rtube) and ventilator circuit (Rvent)) was calculated as the te/Crs eff ratio. In the absence of flow limitation Rrs was obtained by subtracting Rtube and Rvent from Rtot, while in the presence of flow limitation Rrs equaled Rtot. The te of the pure respiratory system (ters) was calculated as the product of Rrs and Crs eff .At zero PEEP, ters increased significantly towards the end of expiration (52¡31%) due to a significant increase in Rrs (46¡36%). Application of PEEP significantly decreased Rrs at the end of expiration and resulted in a faster and relatively constant rate of lung emptying.In conclusion, without positive end-expiratory pressure the respiratory system in patients with acute respiratory distress syndrome deflates with a rate that progressively decreases, due to a considerable increase in expiratory resistance at low lung volumes. Application of positive end-expiratory pressure decreases the expiratory resistance, probably by preventing airway closure, and as a result modifies the pattern of lung emptying.

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Section: Discussionmentioning

confidence: 99%

Lung emptying in patients with acute respiratory distress syndrome: effects of positive end-expiratory pressure

Kondili¹,

Prinianakis²,

Athanasakis³

et al. 2002

European Respiratory Journal

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“…Mols et al suggested that the intra-tidal compliance-volume curve, calculated by the SLICE method (Guttmann et al, 1994), was able to indicate the ongoing recruitment and overdistension of alveoli in the lung (Mols et al, 1999). The shapes of the Fig.…”

Section: Optimizing Peep With Lung Mechanicsmentioning

confidence: 99%

“…compliance-volume curves are classified into three categories: 1) a decrease in slope indicates overdistension; 2) an increase in slope indicates recruitment; 3) a quasi-horizontal compliance-volume curve indicates a suitable PEEP setting (Mols et al, 1999). However, the method has not yet been evaluated for clinical relevance.…”

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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“…Mols et al [2] propose a concept for ventilator setting concerning the intratidal compliance-volume curve determined on the basis of the SLICE method: First, they translate the "S-shape" pressure-volume curve into its first derivation, the trapeziform compliance-volume curve. After that, they define six different shape categories ( Fig.…”

Section: Introductionmentioning

confidence: 99%

Quality index control system for shape identification of intratidal compliance-volume curve with fuzzy logic

Lozano‐Zahonero

Buehler

Schumann

et al. 2013

Biomedical Engineering / Biomedizinische Technik

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Volume-dependent compliance in ARDS: proposal of a new diagnostic concept

Cited by 74 publications

References 41 publications

Lung emptying in patients with acute respiratory distress syndrome: effects of positive end-expiratory pressure

Lung emptying in patients with acute respiratory distress syndrome: effects of positive end-expiratory pressure

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

Quality index control system for shape identification of intratidal compliance-volume curve with fuzzy logic

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