Volume Distribution and Ventilatory Modes in Patients with Acute Respiratory Distress Syndrome

  • C. Chopin
  • M. C. Chambrin
Conference paper


Since the first publication by Gattinoni et al., who used high resolution CT scans, it is well documented that acute respiratory distress syndrome (ARDS) is a heterogeneous lung disease [1]. Morphological examination of the lung shows structural alterations depending on the stage of this disease [2]. In the acute exudative stage an increased permeability of the alveolar barrier is responsible for a widespread interstitial oedema. As the disease progresses, interstitial fluid containing fibrin escapes toward the alveolar space, generating alveolar oedema, hyaline membrane; leukocytes accumulation occurs. Interstitial and alveolar oedema are predominantly distributed in the dependent area of the lung which are the dorsal regions for patients in supine position. Measured at this early stage, lung compliance (CL) and end expiratory lung volume (EELV) are low, airway resistance (Raw) is normal or slightly high. Application of moderate positive end expiratory pressure (PEEP) is sufficient to recruit a large amount of non functional alveoli. This recruitment phenomenon is responsible for a decrease in the intrapulmonary shunt along with PaO2, EELV and CL increase [3]. The subacute proliferative stage is characterized by type II pneumocyte hyperplasia and fibroblast colonization. At this stage main features are a decrease in CL and EELV and an increase in airway resistance [4, 5]. Application of PEEP and positive inspiratory pressure (PIP), even at high level, is not able to recruit the consolidated parts of the lung. However, high level of PIP is responsible for overdistension of the remaining normally aerated pulmonary units submitted to very high transpulmonary pressure gradient which therefore receive the main part of the tidal volume.


Acute Respiratory Distress Syndrome Adult Respiratory Distress Syndrome Acute Respiratory Distress Syndrome Patient Ventilatory Mode Intrapulmonary Shunt 
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Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • C. Chopin
    • 1
  • M. C. Chambrin
    • 2
  1. 1.Dept. of Anaesthesia and Intensive CareR. Salengro HospitalLilleFrance
  2. 2.INSERMUniversity of Lille IILilleFrance

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