Mechanism of airway closure in acute respiratory distress syndrome: a possible role of surfactant depletion
We recently reported the presence of airway closure in patients with acute respiratory distress syndrome (ARDS), evidenced by a low-flow inflation pressure–volume (P–V) curve . We noticed that the initial slope of the respiratory system P–V curve was extremely low in some patients and corresponded to the compliance of the circuit, therefore suggesting complete airway closure. Respiratory system compliance (Crs) suddenly increased above a threshold, named airway opening pressure (AOP) . We concluded that 1) AOP have been missed in the past, and 2) mechanisms leading to airway closure are unknown. Some data suggest that the air–liquid interface creates high surface tension in the small airways and could cause their closure. Surfactant depletion, as often observed in ARDS, could play a role.
Using previously published data, we conducted a post hoc analysis of a study investigating the relationship between P–V curves and bronchoalveolar lavage (BAL) in ARDS . Our...
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Conflicts of interest
RC reports travel expenses to attend scientific meetings by MSD and Fisher & Paykel. None for CL and LC. LB’s laboratory has received grants or equipment from Covidien-Medtronic, Fisher Paykel, Air Liquide, Philips, General Electric.