Conclusion
In view of this slow lung mechanics phenomenon, it is worth considering whether a slow inflation procedure to obtain a quasistatic inspiratory pressure-volume curve has a duration that is sufficient to give adequate information of the slow ‘moulding’ process of the lung. It may be better to use a stepwise up and down PEEP ladder during on-going ventilation where lung mechanics are evaluated with a combination of functional residual capacity measurements and breath-by-breath measurements of volume-dependent compliance. The PEEP ladder functional residual capacity measurements would give data on the slow compliance phenomenon, and the volume-dependent compliance measurements would provide information on the fast compliance. In combination, these measurements may improve the rationale for setting PEEP and tidal volume to minimize lung damage.
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References
Amato MB, Barbas CS, Medeiros DM, et al (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338:347–354
The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308
Barberis L, Manno E, Guerin C (2003) Effect of end-inspiratory pause duration on plateau pressure in mechanically ventilated patients. Intensive Care Med 29:130–134
Guttmann J, Eberhard L, Fabry B, et al (1994) Determination of volume-dependent respiratory system mechanics in mechanically ventilated patients using the new SLICE method. Technol Health Care 2:175–191
Mols G, Brandes I, Kessler V, et al (1999) Volume-dependent compliance in ARDS: proposal of a new diagnostic concept. Intensive Care Med 25:1084–1091
Karason S, Sondergaard S, Lundin S, Wiklund J, Stenqvist O (2000) A new method for non-invasive, manoeuvre-free determination of “static” pressure-volume curves during dynamic/therapeutic mechanical ventilation. Acta Anaesthesiol Scand 44:578–585
Sondergaard S, Karason S, Wiklund J, Lundin S, Stenqvist O (2003) Alveolar pressure monitoring: an evaluation in a lung model and in patients with acute lung injury. Intensive Care Med 29:955–962
Grasso S, Terragni P, Mascia L, et al (2004) Airway pressure-time curve profile (stress index) detects tidal recruitment/hyperinflation in experimental acute lung injury. Crit Care Med 32:1018–1027
Ranieri VM, Zhang H, Mascia L, et al (2000) Pressure-time curve predicts minimally injurious ventilatory strategy in an isolated rat lung model. Anesthesiology 93:1320–1328
Stenqvist O (2003) Practical assessment of respiratory mechanics. Br J Anaesth 91:92–105
Neumann P, Berglund JE, Mondejar EF, Magnusson A, Hedenstierna G (1998) Dynamics of lung collapse and recruitment during prolonged breathing in porcine lung injury. J Appl Physiol 85:1533–1543
Olegard C, Sondergaard S, Houltz E, Lundin S, Stenqvist O (2005) Estimation of functional residual capacity at the bedside using standard monitoring equipment: a modified nitrogen washout/washin technique requiring a small change of the inspired oxygen fraction. Anesth Analg 101:206–212
Stenqvist O, Olegard C, Sondergaard S, Odenstedt H, Karason S, Lundin S (2002) Monitoring functional residual capacity (FRC) by quantifying oxygen/carbon dioxide fluxes during a short apnea. Acta Anaesthesiol Scand 46:732–739
Frerichs I, Dargaville PA, Dudykevych T, Rimensberger PC (2003) Electrical impedance tomography: a method for monitoring regional lung aeration and tidal volume distribution? Intensive Care Med 29:2312–2316
Hickling KG (2001) Best compliance during a decremental, but not incremental, positive end-expiratory pressure trial is related to open-lung positive end-expiratory pressure: a mathematical model of acute respiratory distress syndrome lungs. Am J Respir Crit Care Med 163:69–78
Odenstedt H, Lindgren S, Olegard C, et al (2005) Slow moderate pressure recruitment maneuver minimizes negative circulatory and lung mechanic side effects: evaluation of recruitment maneuvers using electric impedance tomography. Intensive Care Med 31:1706–1714
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Stenqvist, O., Odenstedt, H., Lundin, S. (2006). Fast and Slow Compliance: Time, in Addition to Pressure and Volume, is a Key Factor for Lung Mechanics. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine. Yearbook of Intensive Care and Emergency Medicine, vol 2006. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-33396-7_38
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