Parameters Derived from the Pulmonary Pressure–Volume Curve, but Not the Pressure–Time Curve, Indicate Recruitment in Experimental Lung Injury

Henzler, Dietrich; Hochhausen, Nadine; Dembinski, Rolf; Orfao, Sandra; Rossaint, Rolf; Kuhlen, Ralf

doi:10.1213/01.ane.0000278733.94863.09

Cited by 12 publications

(10 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, additional information can be obtained from analysis of the whole respiratory cycle [9]. The relations between ventilator settings and intrapulmonary phenomena have been modeled theoretically only [10], which did not lead to consequences in clinical decision making.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Sigmoidal Equations To Describe the Pulmonary Pressure- Volume Curve in Acute Respiratory Distress Syndrome~!2008-09-18~!2008-10-27~!2008-12-05~!

Orfao¹,

Hochhausen²,

Kuhlen³

et al. 2008

TOCCMJ

Self Cite

View full text Add to dashboard Cite

Pulmonary pressure-volume curves (P-V curves) of patients with acute lung injury are commonly analyzed using a parametric algorithm with symmetrical properties. Some of the aspects observed after performing nonlinear regression for two models capable of fitting symmetric, respectively asymmetric data are discussed.One analyzed aspect was the algebraic complexity of the asymmetric model that does not allow for an estimation of the boundaries of the zone of maximal compliance directly from the parameter estimates in contrast to the symmetric model. Moreover, mathematical evidence is provided.Using a sigmoid equation for analysis of P-V curves a systematic deviation caused by asymmetrical distribution was encountered, leading to non-robust definitions of lower and upper inflection points. Increasing the number of parameters to fit asymmetric data does not increase physiological expression.We conclude that some of the drawbacks in using P-V curves may be attributed to imprecise analysis tools. To increase the value of P-V curves other forms of mathematical analysis should be investigated.

show abstract

Section: Discussionmentioning

confidence: 99%

Analysis of Sigmoidal Equations To Describe the Pulmonary Pressure- Volume Curve in Acute Respiratory Distress Syndrome~!2008-09-18~!2008-10-27~!2008-12-05~!

Orfao¹,

Hochhausen²,

Kuhlen³

et al. 2008

TOCCMJ

Self Cite

View full text Add to dashboard Cite

show abstract

“…13 There is a general consensus in the literature that opening of lung units occurs along the entire length of the inspiratory limb of the P-V relationship. [37][38][39][40] The effectiveness of PEEP in recruiting alveolar tissue correlates with the value of the Lower Inflexion Point (LIP). 13,[40][41] A range of ventilators have software suitable to measure P-V curves.…”

Section: Whose Lungs Do You Recruit?mentioning

confidence: 99%

“…[37][38][39][40] The effectiveness of PEEP in recruiting alveolar tissue correlates with the value of the Lower Inflexion Point (LIP). 13,[40][41] A range of ventilators have software suitable to measure P-V curves. A method of determining an appropriate figure for SI was calculated by Qiu and colleagues based upon 5 X Mean Airway Pressure (MAP).…”

Section: Whose Lungs Do You Recruit?mentioning

confidence: 99%

Paediatric lung recruitment: a review of the clinical evidence

Jauncey‐Cooke

East

Bogossian

2015

Paediatric Respiratory Reviews

View full text Add to dashboard Cite

“…Sometimes, the LIP can be evaluated by examining a pressurevolume curve. 53 However, at pressures above the upper inflection point (UIP), lung structures are overdistended without further recruitment. 52 Thus, to avoid lung damage, the end-inspiratory pressure should not exceed the UIP.…”

Section: Body Positionmentioning

confidence: 99%

“…53 Monitoring the oxygenation ( paO 2 and SaO 2 ) or the reduction in the end-tidal/arterial CO 2 difference allows detection of the ideal level of PEEP for each patient. 16,73 Such recruitment manoeuvres have the disadvantage that preload is changed due to the increase in intrathoracic pressure.…”

Section: Recruitment Manoeuvresmentioning

confidence: 99%

Physiology of gas exchange during anaesthesia

Bruells

Rossaint

2011

European Journal of Anaesthesiology

Self Cite

View full text Add to dashboard Cite

Mechanical ventilation is a prerequisite for many surgical interventions. Furthermore, during states of severe gas exchange disturbance or impaired neurological conditions with the threat of aspiration or cardiovascular instability, it is a life-saving intervention on every ICU. Even the induction of anaesthesia disturbs the physiological lung function, due to changes in chest wall mechanics and diaphragm relaxation, generating atelectases, gas exchange disturbance and ventilation-perfusion mismatch. Additionally, the application of positive pressure to lung structures elicits ventilator-induced lung injury, with the severity of injury dependent on the applied volume, peak pressures and levels of positive end-expiratory pressure. Although these pathophysiological changes may be of minor importance for the majority of ventilated patients in the operating room, these mechanisms may harm patients during surgical interventions with the need for one-lung ventilation or with underlying co-morbidities such as chronic obstructive pulmonary disease (COPD) or acute respiratory distress syndrome (ARDS). This review provides an outline of the major components of the pathophysiological changes associated with general anaesthesia and describes the additional risks in patients with COPD and ARDS as common co-morbidities in every hospital.

show abstract

Parameters Derived from the Pulmonary Pressure–Volume Curve, but Not the Pressure–Time Curve, Indicate Recruitment in Experimental Lung Injury

Abstract: Parameters derived from the PV curve may help in characterizing the lung aeration of the lung and in indicating recruitment. In the presence of lung-protective ventilator settings, the stress index derived from the Paw-t curve was not able to indicate recruitment.

Cited by 12 publications

References 45 publications

Analysis of Sigmoidal Equations To Describe the Pulmonary Pressure- Volume Curve in Acute Respiratory Distress Syndrome~!2008-09-18~!2008-10-27~!2008-12-05~!

Analysis of Sigmoidal Equations To Describe the Pulmonary Pressure- Volume Curve in Acute Respiratory Distress Syndrome~!2008-09-18~!2008-10-27~!2008-12-05~!

Paediatric lung recruitment: a review of the clinical evidence

Physiology of gas exchange during anaesthesia

Contact Info

Product

Resources

About