JOURNAL ARTICLE
RESEARCH SUPPORT, NON-U.S. GOV'T
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Alveolar Tidal recruitment/derecruitment and Overdistension During Four Levels of End-Expiratory Pressure with Protective Tidal Volume During Anesthesia in a Murine Lung-Healthy Model.

Lung 2018 June
PURPOSE: We compared respiratory mechanics between the positive end-expiratory pressure of minimal respiratory system elastance (PEEPminErs ) and three levels of PEEP during low-tidal-volume (6 mL/kg) ventilation in rats.

METHODS: Twenty-four rats were anesthetized, paralyzed, and mechanically ventilated. Airway pressure (Paw ), flow (F), and volume (V) were fitted by a linear single compartment model (LSCM) Paw (t) = Ers  × V(t) + Rrs  × F(t) + PEEP or a volume- and flow-dependent SCM (VFDSCM) Paw (t) = (E1  + E2  × V(t)) × V(t) + (K1  + K2  × |F(t)|) × F(t) + PEEP, where Ers and Rrs are respiratory system elastance and resistance, respectively; E1 and E2 × V are volume-independent and volume-dependent Ers , respectively; and K1 and K2  × F are flow-independent and flow-dependent Rrs , respectively. Animals were ventilated for 1 h at PEEP 0 cmH2 O (ZEEP); PEEPminErs ; 2 cmH2 O above PEEPminErs (PEEPminErs+2 ); or 4 cmH2 O above PEEPminErs (PEEPminErs+4 ). Alveolar tidal recruitment/derecruitment and overdistension were assessed by the index %E2  = 100 × [(E2  × VT )/(E1  + |E2 | × VT )], and alveolar stability by the slope of Ers (t).

RESULTS: %E2 varied between 0 and 30% at PEEPminErs in most respiratory cycles. Alveolar Tidal recruitment/derecruitment (%E2  < 0) and overdistension (%E2  > 30) were predominant in the absence of PEEP and in PEEP levels higher than PEEPminErs , respectively. The slope of Ers (t) was different from zero in all groups besides PEEPminErs+4 .

CONCLUSIONS: PEEPminErs presented the best compromise between alveolar tidal recruitment/derecruitment and overdistension, during 1 h of low-VT mechanical ventilation.

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