Skip to main content
SpringerLink
Log in
Book cover

Yearbook of Intensive Care and Emergency Medicine 1998 pp 430–440Cite as

The Open Lung Concept

  • Conference paper

Part of the book series: Yearbook of Intensive Care and Emergency Medicine ((YEARBOOK,volume 1998))

Abstract

The imperative: “Open up the lung and keep the lung open” from Lachmann’s editorial [1] has been quoted many times. The implied rationale, however, has been a matter of debate: Why should we open the lung? What is an open lung? In addition, questions concerning the methodology were asked: How can we open the lung without risking barotrauma? How should we keep the lung open with the least possible side effects? Today, exactly 20 years after the first description of the open lung concept by Lachmann and colleagues [2, 3], this article will address the physiologic and clinical rationale of the opening procedure, and will explain the steps necessary to open the lung.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Lachmann B (1992) Open up the lung and keep the lung open. Intensive Care Med 118: 319–321

    Google Scholar 

  2. Lachmann B, Bergmann KC, Enders K, et al (1977) Können pathologische Veränderungen im Surfactant-System der Lunge zu einer akuten respiratorischen Insuffizienz beim Erwachsenen führen? In: Danzmann E (ed) Anaesthesia 77, Proceedings of the 6th Congress of the Society of Anaesthesiology and Resuscitation of the GDR Vol. 1 Soc Anesthesiol and Resuscitation of the GDR, Berlin, pp 337–353

    Google Scholar 

  3. Haendly B, Lachmann B, Schulz H, Jonson B (1978) Der Einfluß verschiedener Beatmungs¬muster auf Lungenmechanik und Gasaustausch bei Patienten während Respiratorbehandlung. Kongreßbericht Anaesthesie 1: 665–678

    Google Scholar 

  4. Lichtwarck-Aschoff M, Nielsen JB, Sjöstrand UH, Edgren E (1992) An experimental randomized study of five different ventilatory modes in a piglet model of severe respiratory distress. Intensive Care Med 18: 339–347

    Article  PubMed  CAS  Google Scholar 

  5. Sjöstrand UH, Lichtwarck-Aschoff M, Nielsen JB,et al (1995) Different ventilatory approaches to keep the lung open. Intensive Care Med 21: 310–318

    Article  PubMed  Google Scholar 

  6. Kesecioglu J, Tibboel D, Lachmann B (1994) Advantages and rationale for pressure control ven-tilation. In: Vincent JL (ed) Yearbook of intensive care and emergency medicine. Springer-Verlag, Berlin, Heidelberg, New York, pp 524–533

    Google Scholar 

  7. Lachmann B, Danzmann E, Haendly B, Jonson B (1982) Ventilator settings and gas exchange in respiratory distress syndrome. In: Prakash O (ed) Applied physiology in clinical respiratory care. Nijhoff, The Hague, pp 141–176

    Google Scholar 

  8. Ashbaugh DG, Bingelow DB, Petty TL, Levine BE (1967) Acute respiratory distress in adults. Lancet 2: 319–323

    Article  PubMed  CAS  Google Scholar 

  9. Ashbaugh DG, Petty TL, Bigelow DB, et al (1969) Continuous positive pressure breathing (CPPB) in the adult respiratory distress syndrome. J Thorac Cardiovasc Surg 57: 31–41

    PubMed  CAS  Google Scholar 

  10. Tremblay NL, Slutsky AS (1996) The role of pressure and volume in ventilation induced lung injury. Appl Cardiopulm Pathophysiol 6: 179–190

    Google Scholar 

  11. Mead J (1961) Mechanical properties of lungs. Physiol Rev 41: 281–330

    PubMed  CAS  Google Scholar 

  12. Dreyfuss D, Soler P, Basset G, Saumon G (1988) High inflation pressure pulmonary edema. Am Rev Respir Dis 137: 1159–1164

    PubMed  CAS  Google Scholar 

  13. Dreyfuss D, Basset G, Soler P, Saumon G (1985) Intermittent positive pressure hyperventilation with high inflation pressures produces pulmonary microvascular injury in rats. Am Rev Respir Dis 132: 880–884

    PubMed  CAS  Google Scholar 

  14. Dreyfuss D, Soler P, Basset G, Saumon G (1988) High inflation pressure pulmonary edema: respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis 137: 1159–1164

    PubMed  CAS  Google Scholar 

  15. Dreyfuss D, Saumon G (1993) Role of tidal volume, FRC, and end-inspiratory volume in the development of pulmonary edema following mechanical ventilation. Am Rev Respir Dis 148: 1194–1203

    PubMed  CAS  Google Scholar 

  16. Webb HH, Tier ney DF (1974) Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures: protection by positive end-expiratory pressure. Am Rev Respir Dis 110: 556–565

    PubMed  CAS  Google Scholar 

  17. Muscedere JG, Mullen JB, Gan K, Slutzky AS (1994) Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med 149: 1327–1334

    PubMed  CAS  Google Scholar 

  18. Amato MBP, Barbas CSV, Pastore L, et al (1996) Minimizing barotrauma in ARDS: Protective effects of PEEP and the hazards of driving and plateau pressures. Am J Respir Crit Care Med 153: 375A (abst)

    Google Scholar 

  19. Froese AB, McCulloch PR, Sugiura M, et al (1993) Optimizing alveolar expansion prolongs the effectiveness of exogenous surfactant therapy in the adult rabbit. Am Rev Respir Dis 148: 569–577

    Article  PubMed  CAS  Google Scholar 

  20. Mead J, Takishima T, Leith D (1970) Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol 28: 596–608

    PubMed  CAS  Google Scholar 

  21. Schwieler G, Robertson B (1976) Liquid ventilation in immature newborn rabbits. Biol Neonate 29: 343–353

    Article  PubMed  CAS  Google Scholar 

  22. Bond D, Froese B (1993) Volume recruitment maneuvers are less deleterious than persistent low lung volumes in the atelectasis prone rabbit lung during high-frequency oscillation. Crit Care Med 21: 402–412

    Article  PubMed  CAS  Google Scholar 

  23. Taskar V, John J, Evander E, et al (1997) Surfactant dysfunction makes the lungs vulnerable to repetitive collapse and reexpansion. Am J Physiol 155: 313–320

    CAS  Google Scholar 

  24. Tremblay L, Valenza F, Ribeiro S, Jingfang L, Slutsky A (1997) Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model. J Clin Invest 99: 944–952

    Article  PubMed  CAS  Google Scholar 

  25. Bethmann von A, Brasch F, Müller K, Wndel A, Uhlig S (1996) Prolonged hyperventilation is required for release of tumor necrosis factor-a but not IL-6. Appl Cardiopulm Pathophysiol 6: 179–190

    Google Scholar 

  26. Von Neergaard K (1929) Neue Auffassungen über einen Grundbegriff der Atemmechanik; Die Retraktionskraft der Lunge, abhängig von der Oberflächenspannung in den Alveolen. Z Ges Exp Med 66: 373–394

    Article  Google Scholar 

  27. LaPlace PS (1798-1827) Traite de Mecanique Celeste. Crapelet, Courcier, Paris

    Google Scholar 

  28. Mclntyre R, Laws A, Ramachandran P (1969) Positive expiratory pressure plateau: improved gas exchange during mechanical ventilation. Can Anaes Soc J 16: 477–487

    Article  Google Scholar 

  29. Böhm S, Lachrnann B (1996) Pressure-control ventilation. Putting a mode into perspective. Int J Intensive Care 3: 12–27

    Google Scholar 

  30. Staub N, Nagano H, Pearce, Spring ML (1967) Pulmonary edema in dogs, especially the sequence of fluid accumulation in lungs. J Appl Physiol 22: 227–240

    PubMed  CAS  Google Scholar 

  31. Wegenius G (1991) Model simulations of pulmonary edema. Phantom studies with computer tomography. Invest Radiol 26: 149–156

    Article  PubMed  CAS  Google Scholar 

  32. Wegenius G,Wickerts CJ,Hedenstierna G (1994) Radiological assessment of pulmonary edema. A new principle. Eur J Radiol 4: 146–154

    Google Scholar 

  33. Slutsky A (1994) Consensus conference on mechanical ventilation January 28–30,1993 at Northbrook, Illinois, USA. Part 1. Intensive Care Med 20: 64–79

    Article  PubMed  CAS  Google Scholar 

  34. Slutsky A (1994) Consensus conference on mechanical ventilation January 28–30,1993 at North- brook, Illinois, USA. Part 2. Intensive Care Med 20: 150–162

    Article  CAS  Google Scholar 

  35. Gattinoni L, Pelosi P, Crotti S, Valenza F (1995) Effects of positive end-expiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome. Am J Respir Crit Care Med 151: 1807–1814

    PubMed  CAS  Google Scholar 

  36. Amato MBP, Barbas CSV, Medeiros DM, et al (1995) Beneficial effects of the “Open Lung Approach” with low distending pressures in acute respiratory distress syndrome. Am J Respir Crit Care Med 152: 1835–1846

    PubMed  CAS  Google Scholar 

  37. Hedenstierna G, Tokics L, Strandberg A, Lundquist H, Brismar B (1986) Correlation of gas exchange impairment to development of atelectasis during anaesthesia and muscle paralysis. Acta Anaesthesiol Scand 30: 183–191

    Article  PubMed  CAS  Google Scholar 

  38. Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G (1993) Reexpansion of atelectasis during general anaesthesia: a computed tomography study. Br J Anaesth 71: 788–795

    Article  PubMed  CAS  Google Scholar 

  39. Hedenstierna G, Lundquist H, Lundh B, et al (1989) Pulmonary densities during anaesthesia. An experimental study on lung morphology and gas exchange. Eur Respir J 2: 528–535

    PubMed  CAS  Google Scholar 

  40. Hedenstierna G, Tokics L, Strandeberg A, Lundquist H, Brismar B (1986) Correlation of gas exchange impairment to development of atelectasis during anaesthesia and muscle paralysis. Acta Anaesthesiol Scand 30: 183–191

    Article  PubMed  CAS  Google Scholar 

  41. Gattinoni L, Pesenti A, Avalli L, Rossi F, Bombino M, (1987) Pressure-volume curve of total respiratory system in acute respiratory failure. A computed tomographic scan study. Am Rev Respir Dis 136: 730–736

    Article  PubMed  CAS  Google Scholar 

  42. Bendixen H, Hedley Whyte J, Chir B, Laver M (1963) Impaired oxygenation in surgical patients during general anesthesia with controlled ventilation. A concept of atelectasis. N Engl J Med 269: 991–996

    Article  PubMed  CAS  Google Scholar 

  43. Housley E, Louyada N, Becklake M (1970) To sigh or not to sigh. Am Rev Respir Dis 101: 611–614

    PubMed  CAS  Google Scholar 

  44. Lachmann B, Jonson B, Lindroth M, Robertson B (1982) Modes of artificial ventilation in severe respiratory distress syndrome. Lung function and morphology in rabbits after washout of alveolar surfactant. Crit Care Med 10: 724–732

    Article  PubMed  CAS  Google Scholar 

  45. Dreyfuss D, Saumon G (1994) Should the lung be rested or recruited? The Charybdis and Scylla of ventilator management. Am Rev Respir Crit Care Med 149: 1066–1068

    CAS  Google Scholar 

  46. McCulloch P, Forkert G, Froese A (1988) Lung volume maintenance prevents lung injury during high frequency oscillatory ventilation in surfactant-deficient rabbits. Am Rev Respir Dis 137: 1185–1192

    PubMed  CAS  Google Scholar 

  47. Froese A (1997) High-frequency oscillatory ventilation for adult respiratory distress syndrome: let’s get it right this time. Crit Care Med 25: 906–908

    Article  PubMed  CAS  Google Scholar 

  48. Froese A, Bryan Ch (1987) High frequency ventilation. Am Rev Respir Dis 135: 1363–1374

    PubMed  CAS  Google Scholar 

  49. Amato MBP, Barbas CSV, Medeiros, et al (1996) Improved survival in ARDS: beneficial effects of a lung protective strategy. Am J Respir Crit Care Med 153: A531 (Abst)

    Google Scholar 

  50. Snyder JV, Froese A (1987) The open lung approach: Concept and application. In: Snyder JV, Pinsky MR (eds) Oxygen transport in the critically ill. Year Book medical publishers Inc., Chicago, pp 374–395

    Google Scholar 

Download references

Authors
  1. S. H. Böhm
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. F. Vazquez de Anda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Lachmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Intensive Care, Erasme Hospital, Free University of Brussels, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean-Louis Vincent (Clinical Director) (Clinical Director)

Rights and permissions

Reprints and permissions

Copyright information

© 1998 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Böhm, S.H., Vazquez de Anda, G.F., Lachmann, B. (1998). The Open Lung Concept. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine 1998. Yearbook of Intensive Care and Emergency Medicine, vol 1998. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-72038-3_37

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-72038-3_37

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-63798-1

  • Online ISBN: 978-3-642-72038-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation