TY - JOUR
T1 - Potential for lung recruitment estimated by the recruitment-to-inflation ratio in acute respiratory distress syndrome a clinical trial
AU - Chen, Lu
AU - Del Sorbo, Lorenzo
AU - Grieco, Domenico L.
AU - Junhasavasdikul, Detajin
AU - Rittayamai, Nuttapol
AU - Soliman, Ibrahim
AU - Sklar, Michael C.
AU - Rauseo, Michela
AU - Ferguson, Niall D.
AU - Fan, Eddy
AU - Richard, Jean Christophe M.
AU - Brochard, Laurent
N1 - Publisher Copyright:
Copyright © 2020 by the American Thoracic Society.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/1/15
Y1 - 2020/1/15
N2 - Rationale: Response to positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome depends on recruitability. We propose a bedside approach to estimate recruitability accounting for the presence of complete airway closure. Objectives: To validate a single-breath method for measuring recruited volume and test whether it differentiates patients with different responses to PEEP. Methods: Patients with acute respiratory distress syndrome were ventilated at 15 and 5 cm H2O of PEEP. Multiple pressure–volume curves were compared with a single-breath technique. Abruptly releasing PEEP (from 15 to 5 cm H2O) increases expired volume: the difference between this volume and the volume predicted by compliance at low PEEP (or above airway opening pressure) estimated the recruited volume by PEEP. This recruited volume divided by the effective pressure change gave the compliance of the recruited lung; the ratio of this compliance to the compliance at low PEEP gave the recruitment-to-inflation ratio. Response to PEEP was compared between high and low recruiters based on this ratio. Measurements and Main Results: Forty-five patients were enrolled. Four patients had airway closure higher than high PEEP, and thus recruitment could not be assessed. In others, recruited volume measured by the experimental and the reference methods were strongly correlated (R2 = 0.798; P, 0.0001) with small bias (221 ml). The recruitment-to-inflation ratio (median, 0.5; range, 0–2.0) correlated with both oxygenation at low PEEP and the oxygenation response; at PEEP 15, high recruiters had better oxygenation (P = 0.004), whereas low recruiters experienced lower systolic arterial pressure (P = 0.008). Conclusions: A single-breath method quantifies recruited volume. The recruitment-to-inflation ratio might help to characterize lung recruitability at the bedside.
AB - Rationale: Response to positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome depends on recruitability. We propose a bedside approach to estimate recruitability accounting for the presence of complete airway closure. Objectives: To validate a single-breath method for measuring recruited volume and test whether it differentiates patients with different responses to PEEP. Methods: Patients with acute respiratory distress syndrome were ventilated at 15 and 5 cm H2O of PEEP. Multiple pressure–volume curves were compared with a single-breath technique. Abruptly releasing PEEP (from 15 to 5 cm H2O) increases expired volume: the difference between this volume and the volume predicted by compliance at low PEEP (or above airway opening pressure) estimated the recruited volume by PEEP. This recruited volume divided by the effective pressure change gave the compliance of the recruited lung; the ratio of this compliance to the compliance at low PEEP gave the recruitment-to-inflation ratio. Response to PEEP was compared between high and low recruiters based on this ratio. Measurements and Main Results: Forty-five patients were enrolled. Four patients had airway closure higher than high PEEP, and thus recruitment could not be assessed. In others, recruited volume measured by the experimental and the reference methods were strongly correlated (R2 = 0.798; P, 0.0001) with small bias (221 ml). The recruitment-to-inflation ratio (median, 0.5; range, 0–2.0) correlated with both oxygenation at low PEEP and the oxygenation response; at PEEP 15, high recruiters had better oxygenation (P = 0.004), whereas low recruiters experienced lower systolic arterial pressure (P = 0.008). Conclusions: A single-breath method quantifies recruited volume. The recruitment-to-inflation ratio might help to characterize lung recruitability at the bedside.
KW - Acute respiratory distress syndrome
KW - Artificial respiration
KW - Mechanical ventilators
KW - Positive-pressure respiration
KW - Respiratory mechanics
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U2 - 10.1164/rccm.201902-0334OC
DO - 10.1164/rccm.201902-0334OC
M3 - Article
C2 - 31577153
AN - SCOPUS:85077934538
VL - 201
SP - 178
EP - 187
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
SN - 1073-449X
IS - 2
ER -