Incidence and regional distribution of lung overinflation during mechanical ventilation with positive end-expiratory pressure

Critical Care Medicine
Ania NieszkowskaJ J Rouby

Abstract

In patients with acute lung injury, alveolar recruitment resulting from positive end-expiratory pressure (PEEP) may be associated with overinflation of previously aerated lung regions. The aim of this study was to assess the incidence and regional distribution of lung overinflation resulting from mechanical ventilation with PEEP. Reanalysis with a specific software including a color-coding system of quantitative lung computed tomography data obtained in four previous prospective studies. A 20-bed surgical intensive care unit of a Parisian university hospital. Thirty-two patients with acute lung injury in whom computed tomography of the whole lung was obtained at zero end-expiratory pressure (ZEEP) and PEEP 15 cm H2O. None. Total lung recruitment was measured as the reaeration of poorly aerated (computed tomography attenuations ranging between -500 and -100 Hounsfield units) and nonaerated (computed tomography attenuations > or = -100 Hounsfield units) lung areas, and overinflation was measured as the lung volume characterized by computed tomography attenuations < or = -900 Hounsfield units. PEEP was associated with a significant alveolar recruitment (423 +/- 178 mL). Concomitantly, a lung overinflation of 123 +/- 138 mL was fou...Continue Reading

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