Effects of volume shift on the pressure-volume curve of the respiratory system in ALI/ARDS patients

D. Chiumello, E. Carlesso, A. Aliverti, R. L. Dellacà, A. Pedotti, P. P. Pelosi, L. Gattinoni

Research output: Contribution to journalArticlepeer-review

Abstract

Aim. The pressure-volume (PV) curve in acute lung injury and acute respiratory distress syndrome (ALI/ARDS) patients has been proposed for estimating the underlying pathology, lung recruitment and setting mechanical ventilation. The supersyringe method may lead to artifacts due to thermodynamics and gas exchange. Another possible confounding factor is the volume shift, primarily blood, out of the chest wall when the intrathoracic pressures rise. We set out to quantify the volume shift and investigate its mechanisms. Methods. Ten ALI/ARDS patients (5 males/5 females, PaO2/FiO2 222±67) were studied in the Intensive Care Unit, University Hospital. PV curve was performed by a supersyringe (0.100 L, 14 steps ΔVgas) while recording the chest wall volume difference (ΔVcw) by the optoelectronic plethysmography. Differences in airway (ΔPaw) and esophageal (ΔPes) pressures were measured during the maneuver. Volume shift was defined as ΔVcw-ΔVgas, corrected for thermodynamic and gas exchange. Results. Starting compliance (P2=0.87, P2=0.80, P2=0.42, P2=0.58, P2O of airway pressure the volume shift between the inflation and deflation limbs of the PV curve amounted to 0.099±0.058 L. Conclusion. The volume shift, constituted mainly of blood, significantly affects both inspiratory and expiratory PV curve. Caution is needed when interpreting the PV parameters.

Original languageEnglish
Pages (from-to)109-118
Number of pages10
JournalMinerva Anestesiologica
Volume73
Issue number3
Publication statusPublished - Mar 2007

Keywords

  • Acute lung injury
  • Acute respiratory distress syndrome
  • Diagnostic techniques and procedures
  • Lung compliance
  • Respiratory mechanics

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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