Lung opening and closing during ventilation of acute respiratory distress syndrome

Pietro Caironi, Massimo Cressoni, Davide Chiumello, Marco Ranieri, Michael Quintel, Sebastiano G. Russo, Rodrigo Cornejo, Guillermo Bugedo, Eleonora Carlesso, Riccarda Russo, Luisa Caspani, Luciano Gattinoni

Research output: Contribution to journalArticle

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Abstract

Rationale:Theeffects of high positive end-expiratory pressure (PEEP) strictly depend on lung recruitability, which varies widely during acute respiratory distress syndrome (ARDS). Unfortunately, increasing PEEP may lead to opposing effects on two main factors potentially worsening the lung injury, that is, alveolar strain and intratidal opening and closing, being detrimental (increasing the former) or beneficial (decreasing the latter). Objectives: To investigate how lung recruitability influences alveolar strainandintratidalopeningandclosing after the application of high PEEP. Methods:We analyzed data from a database of 68 patients with acute lung injury or ARDS who underwent whole-lung computed tomography at 5, 15, and 45 cm H 2O airway pressure. Measurements and Main Results: End-inspiratory nonaerated lung tissue was estimated from computed tomography pressure - volume curves. Alveolar strain and opening and closing lung tissue were computed at 5 and 15 cm H 2O PEEP. In patients with a higher percentage of potentially recruitable lung, the increase in PEEPmarkedly reduced opening and closing lung tissue (P <0.001), whereas no differences were observed in patients with a lower percentage of potentially recruitable lung. In contrast, alveolar strain similarly increased in the two groups (P = 0.89). Opening and closing lung tissuewasdistributedmainly in the dependent andhilar lung regions, andit appearedtobe an independent risk factor fordeath (odds ratio, 1.10 for each 10-g increase). Conclusions: In ARDS, especially in patients with higher lung recruitability, the beneficial impact of reducing intratidal alveolar opening and closing by increasing PEEP prevails over the effects of increasing alveolar strain.

Original languageEnglish
Pages (from-to)578-586
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume181
Issue number6
DOIs
Publication statusPublished - Mar 15 2010

Fingerprint

Adult Respiratory Distress Syndrome
Ventilation
Lung
Positive-Pressure Respiration
Pressure
Cone-Beam Computed Tomography
Acute Lung Injury
Lung Injury
Odds Ratio
Tomography
Databases

Keywords

  • Acute lung injury
  • Acute respiratory distress syndrome
  • Mechanical ventilation
  • Ventilator-induced lung injury

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Caironi, P., Cressoni, M., Chiumello, D., Ranieri, M., Quintel, M., Russo, S. G., ... Gattinoni, L. (2010). Lung opening and closing during ventilation of acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 181(6), 578-586. https://doi.org/10.1164/rccm.200905-0787OC

Lung opening and closing during ventilation of acute respiratory distress syndrome. / Caironi, Pietro; Cressoni, Massimo; Chiumello, Davide; Ranieri, Marco; Quintel, Michael; Russo, Sebastiano G.; Cornejo, Rodrigo; Bugedo, Guillermo; Carlesso, Eleonora; Russo, Riccarda; Caspani, Luisa; Gattinoni, Luciano.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 181, No. 6, 15.03.2010, p. 578-586.

Research output: Contribution to journalArticle

Caironi, P, Cressoni, M, Chiumello, D, Ranieri, M, Quintel, M, Russo, SG, Cornejo, R, Bugedo, G, Carlesso, E, Russo, R, Caspani, L & Gattinoni, L 2010, 'Lung opening and closing during ventilation of acute respiratory distress syndrome', American Journal of Respiratory and Critical Care Medicine, vol. 181, no. 6, pp. 578-586. https://doi.org/10.1164/rccm.200905-0787OC
Caironi, Pietro ; Cressoni, Massimo ; Chiumello, Davide ; Ranieri, Marco ; Quintel, Michael ; Russo, Sebastiano G. ; Cornejo, Rodrigo ; Bugedo, Guillermo ; Carlesso, Eleonora ; Russo, Riccarda ; Caspani, Luisa ; Gattinoni, Luciano. / Lung opening and closing during ventilation of acute respiratory distress syndrome. In: American Journal of Respiratory and Critical Care Medicine. 2010 ; Vol. 181, No. 6. pp. 578-586.
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abstract = "Rationale:Theeffects of high positive end-expiratory pressure (PEEP) strictly depend on lung recruitability, which varies widely during acute respiratory distress syndrome (ARDS). Unfortunately, increasing PEEP may lead to opposing effects on two main factors potentially worsening the lung injury, that is, alveolar strain and intratidal opening and closing, being detrimental (increasing the former) or beneficial (decreasing the latter). Objectives: To investigate how lung recruitability influences alveolar strainandintratidalopeningandclosing after the application of high PEEP. Methods:We analyzed data from a database of 68 patients with acute lung injury or ARDS who underwent whole-lung computed tomography at 5, 15, and 45 cm H 2O airway pressure. Measurements and Main Results: End-inspiratory nonaerated lung tissue was estimated from computed tomography pressure - volume curves. Alveolar strain and opening and closing lung tissue were computed at 5 and 15 cm H 2O PEEP. In patients with a higher percentage of potentially recruitable lung, the increase in PEEPmarkedly reduced opening and closing lung tissue (P <0.001), whereas no differences were observed in patients with a lower percentage of potentially recruitable lung. In contrast, alveolar strain similarly increased in the two groups (P = 0.89). Opening and closing lung tissuewasdistributedmainly in the dependent andhilar lung regions, andit appearedtobe an independent risk factor fordeath (odds ratio, 1.10 for each 10-g increase). Conclusions: In ARDS, especially in patients with higher lung recruitability, the beneficial impact of reducing intratidal alveolar opening and closing by increasing PEEP prevails over the effects of increasing alveolar strain.",
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AU - Russo, Sebastiano G.

AU - Cornejo, Rodrigo

AU - Bugedo, Guillermo

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N2 - Rationale:Theeffects of high positive end-expiratory pressure (PEEP) strictly depend on lung recruitability, which varies widely during acute respiratory distress syndrome (ARDS). Unfortunately, increasing PEEP may lead to opposing effects on two main factors potentially worsening the lung injury, that is, alveolar strain and intratidal opening and closing, being detrimental (increasing the former) or beneficial (decreasing the latter). Objectives: To investigate how lung recruitability influences alveolar strainandintratidalopeningandclosing after the application of high PEEP. Methods:We analyzed data from a database of 68 patients with acute lung injury or ARDS who underwent whole-lung computed tomography at 5, 15, and 45 cm H 2O airway pressure. Measurements and Main Results: End-inspiratory nonaerated lung tissue was estimated from computed tomography pressure - volume curves. Alveolar strain and opening and closing lung tissue were computed at 5 and 15 cm H 2O PEEP. In patients with a higher percentage of potentially recruitable lung, the increase in PEEPmarkedly reduced opening and closing lung tissue (P <0.001), whereas no differences were observed in patients with a lower percentage of potentially recruitable lung. In contrast, alveolar strain similarly increased in the two groups (P = 0.89). Opening and closing lung tissuewasdistributedmainly in the dependent andhilar lung regions, andit appearedtobe an independent risk factor fordeath (odds ratio, 1.10 for each 10-g increase). Conclusions: In ARDS, especially in patients with higher lung recruitability, the beneficial impact of reducing intratidal alveolar opening and closing by increasing PEEP prevails over the effects of increasing alveolar strain.

AB - Rationale:Theeffects of high positive end-expiratory pressure (PEEP) strictly depend on lung recruitability, which varies widely during acute respiratory distress syndrome (ARDS). Unfortunately, increasing PEEP may lead to opposing effects on two main factors potentially worsening the lung injury, that is, alveolar strain and intratidal opening and closing, being detrimental (increasing the former) or beneficial (decreasing the latter). Objectives: To investigate how lung recruitability influences alveolar strainandintratidalopeningandclosing after the application of high PEEP. Methods:We analyzed data from a database of 68 patients with acute lung injury or ARDS who underwent whole-lung computed tomography at 5, 15, and 45 cm H 2O airway pressure. Measurements and Main Results: End-inspiratory nonaerated lung tissue was estimated from computed tomography pressure - volume curves. Alveolar strain and opening and closing lung tissue were computed at 5 and 15 cm H 2O PEEP. In patients with a higher percentage of potentially recruitable lung, the increase in PEEPmarkedly reduced opening and closing lung tissue (P <0.001), whereas no differences were observed in patients with a lower percentage of potentially recruitable lung. In contrast, alveolar strain similarly increased in the two groups (P = 0.89). Opening and closing lung tissuewasdistributedmainly in the dependent andhilar lung regions, andit appearedtobe an independent risk factor fordeath (odds ratio, 1.10 for each 10-g increase). Conclusions: In ARDS, especially in patients with higher lung recruitability, the beneficial impact of reducing intratidal alveolar opening and closing by increasing PEEP prevails over the effects of increasing alveolar strain.

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KW - Mechanical ventilation

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