Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome

Pier Paolo Terragni, Giulio Rosboch, Andrea Tealdi, Eleonora Corno, Eleonora Menaldo, Ottavio Davini, Giovanni Gandini, Peter Herrmann, Luciana Mascia, Michel Quintel, Arthur S. Slutsky, Luciano Gattinoni, V. Marco Ranieri

Research output: Contribution to journalArticle

Abstract

Rationale: Tidal volume and plateau pressure limitation decreases mortality in acute respiratory distress syndrome. Computed tomography demonstrated a small, normally aerated compartment on the top of poorly aerated and nonaerated compartments that may be hyperinflated by tidal inflation. Objectives: We hypothesized that despite tidal volume and plateau pressure limitation, patients with a larger nonaerated compartment are exposed to tidal hyperinflation of the normally aerated compartment. Measurements and Main Results: Pulmonary computed tomography at end-expiration and end-inspiration was obtained in 30 patients ventilated with a low tidal volume (6 ml/kg predicted body weight). Cluster analysis identified 20 patients in whom tidal inflation occurred largely in the normally aerated compartment (69.9 ± 6.9%; "more protected"), and 10 patients in whomtidal inflation occurred largely within the hyperinflated compartments (63.0 ± 12.7%; "less protected"). The nonaerated compartment was smaller and the normally aerated compartment was larger in the more protected patients than in the less protected patients (p = 0.01). Pulmonary cytokines were lower in the more protected patients than in the less protected patients (p <0.05). Ventilator-free days were 7 ± 8 and 1 ± 2 d in the more protected and less protected patients, respectively (p = 0.01). Plateau pressure ranged between 25 and 26 cm H2O in the more protected patients and between 28 and 30 cm H2O in the less protected patients (p = 0.006). Conclusions: Limiting tidal volume to 6 ml/kg predicted body weight and plateau pressure to 30 cm H2O may not be sufficient in patients characterized by a larger nonaerated compartment.

Original languageEnglish
Pages (from-to)160-166
Number of pages7
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume175
Issue number2
DOIs
Publication statusPublished - 2007

Keywords

  • Acute lung injury
  • Inflammatory response
  • Mechanical ventilation
  • Ventilator-induced lung injury

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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    Terragni, P. P., Rosboch, G., Tealdi, A., Corno, E., Menaldo, E., Davini, O., Gandini, G., Herrmann, P., Mascia, L., Quintel, M., Slutsky, A. S., Gattinoni, L., & Ranieri, V. M. (2007). Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 175(2), 160-166. https://doi.org/10.1164/rccm.200607-915OC