Recruitment-to-inflation Ratio Assessed through Sequential End-expiratory Lung Volume Measurement in Acute Respiratory Distress Syndrome

ConclusionsBoth global and granular recruitment-to-inflation ratio accurately estimate PEEP-induced changes in lung dynamic strain. However, the effect of 10  cm H2O of PEEP on lung strain may be nonuniform. Granular recruitment-to-inflation ratio assessment within narrower PEEP ranges guided by end-expiratory lung volume measurement may aid more precise PEEP selection, especially when the recruitment-to-inflation ratio obtained with the simplified maneuver between PEEP 15 and 5  cm H2O yields intermediate values that are difficult to interpret for a proper choice between a high and low PEEP strategy.Editor ’s PerspectiveWhat We Already Know about This TopicThe ability to determine the optimal positive end-expiratory pressure (PEEP) for patients with acute respiratory distress syndrome may have important clinical ramifications.The optimal PEEP in such patients aims at reducing lung dynamic strain while avoiding baby lung overinflation. The balance between these two effects depends on the variable extent of lung recruitment.The recruitment-to-inflation ratio over a 10 –cm H2O PEEP range has recently been proposed as a simplified method to bedside estimate lung recruitment, but it is undemonstrated if the recruitment-to-inflation ratio accurately reflects PEEP effects on lung strain.Whether the recruitment-to-inflation ratio is uniform or not across a 10 –cm H2O PEEP range is unknown.What This Article Tells Us That Is NewIn a cohort of patients with moderate to severe...
Source: Anesthesiology - Category: Anesthesiology Source Type: research