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Recruitment-to-inflation ratio reflects the impact of peep on dynamic lung strain in a highly recruitable model of ARDS.
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- Author(s): Murgolo, Francesco; Grieco, Domenico L.; Spadaro, Savino; Bartolomeo, Nicola; di Mussi, Rossella; Pisani, Luigi; Fiorentino, Marco; Crovace, Alberto Maria; Lacitignola, Luca; Staffieri, Francesco; Grasso, Salvatore
- Source:
Annals of Intensive Care; 7/4/2024, Vol. 14 Issue 1, p1-12, 12p- Subject Terms:
ADULT respiratory distress syndrome treatment; LUNG radiography; BIOLOGICAL models; SWINE; PEARSON correlation (Statistics); POSITIVE end-expiratory pressure; PULMONARY gas exchange; ADULT respiratory distress syndrome; ACADEMIC medical centers; PULMONARY alveoli; T-test (Statistics); COMPUTED tomography; SCIENTIFIC observation; LUNGS; LUNG injuries; MANN Whitney U Test; MULTIVARIATE analysis; DESCRIPTIVE statistics; HEMODYNAMICS; ARTIFICIAL respiration; ANIMAL experimentation; LUNG volume measurements; COMPARATIVE studies; CONFIDENCE intervals; DATA analysis software; MECHANICAL ventilators; NONPARAMETRIC statistics; RESPIRATORY mechanics - Source:
- Additional Information
- Subject Terms:
- Abstract: Background: The recruitment-to-inflation ratio (R/I) has been recently proposed to bedside assess response to PEEP. The impact of PEEP on ventilator-induced lung injury depends on the extent of dynamic strain reduction. We hypothesized that R/I may reflect the potential for lung recruitment (i.e. recruitability) and, consequently, estimate the impact of PEEP on dynamic lung strain, both assessed through computed tomography scan. Methods: Fourteen lung-damaged pigs (lipopolysaccharide infusion) underwent ventilation at low (5 cmH
2 O) and high PEEP (i.e., PEEP generating a plateau pressure of 28–30 cmH2 O). R/I was measured through a one-breath derecruitment maneuver from high to low PEEP. PEEP-induced changes in dynamic lung strain, difference in nonaerated lung tissue weight (tissue recruitment) and amount of gas entering previously nonaerated lung units (gas recruitment) were assessed through computed tomography scan. Tissue and gas recruitment were normalized to the weight and gas volume of previously ventilated lung areas at low PEEP (normalized-tissue recruitment and normalized-gas recruitment, respectively). Results: Between high (median [interquartile range] 20 cmH2 O [18–21]) and low PEEP, median R/I was 1.08 [0.88–1.82], indicating high lung recruitability. Compared to low PEEP, tissue and gas recruitment at high PEEP were 246 g [182–288] and 385 ml [318–668], respectively. R/I was linearly related to normalized-gas recruitment (r = 0.90; [95% CI 0.71 to 0.97) and normalized-tissue recruitment (r = 0.69; [95% CI 0.25 to 0.89]). Dynamic lung strain was 0.37 [0.29–0.44] at high PEEP and 0.59 [0.46–0.80] at low PEEP (p < 0.001). R/I was significantly related to PEEP-induced reduction in dynamic (r = − 0.93; [95% CI − 0.78 to − 0.98]) and global lung strain (r = − 0.57; [95% CI − 0.05 to − 0.84]). No correlation was found between R/I and and PEEP-induced changes in static lung strain (r = 0.34; [95% CI − 0.23 to 0.74]). Conclusions: In a highly recruitable ARDS model, R/I reflects the potential for lung recruitment and well estimates the extent of PEEP-induced reduction in dynamic lung strain. [ABSTRACT FROM AUTHOR] - Abstract: Copyright of Annals of Intensive Care is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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