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Previous Volume 354:1775-1786 April 27, 2006 Number 17 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Slutsky, A. S. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background In the acute respiratory distress syndrome (ARDS), positive end-expiratory pressure (PEEP) may decrease ventilator-induced lung injury by keeping lung regions open that otherwise would be collapsed. Since the effects of PEEP probably depend on the recruitability of lung tissue, we conducted a study to examine the relationship between the percentage of potentially recruitable lung, as indicated by computed tomography (CT), and the clinical and physiological effects of PEEP.

Methods Sixty-eight patients with acute lung injury or ARDS underwent whole-lung CT during breath-holding sessions at airway pressures of 5, 15, and 45 cm of water. The percentage of potentially recruitable lung was defined as the proportion of lung tissue in which aeration was restored at airway pressures between 5 and 45 cm of water.

Results The percentage of potentially recruitable lung varied widely in the population, accounting for a mean (±SD) of 13±11 percent of the lung weight, and was highly correlated with the percentage of lung tissue in which aeration was maintained after the application of PEEP (r²=0.72, P<0.001). On average, 24 percent of the lung could not be recruited. Patients with a higher percentage of potentially recruitable lung (greater than the median value of 9 percent) had greater total lung weights (P<0.001), poorer oxygenation (defined as a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen) (P<0.001) and respiratory-system compliance (P=0.002), higher levels of dead space (P=0.002), and higher rates of death (P=0.02) than patients with a lower percentage of potentially recruitable lung. The combined physiological variables predicted, with a sensitivity of 71 percent and a specificity of 59 percent, whether a patient's proportion of potentially recruitable lung was higher or lower than the median.

Conclusions In ARDS, the percentage of potentially recruitable lung is extremely variable and is strongly associated with the response to PEEP.

Source Information

From the Istituto di Anestesiologia e Rianimazione, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena di Milano, Università degli Studi di Milano, Milan (L.G., P.C., M.C., D.C.); the Dipartimento di Anestesia, Azienda Ospedaliera San Giovanni Battista–Molinette, Università degli Studi di Torino, Turin, Italy (V.M.R.); Anaesthesiologie II, Operative Intensivmedizin, Universitatsklinikum Gottingen, Gottingen, Germany (M.Q., S.R.); the Dipartimento di Medicina Perioperatoria e Terapia Intensiva, Azienda Ospedaliera San Gerardo di Monza, Università degli Studi Milano–Bicocca, Milan (N.P.); and the Departamentos de Anestesiologia y Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile (R.C., G.B.).

Address reprint requests to Prof. Gattinoni at the Istituto di Anestesiologia e Rianimazione, Fondazione IRCCS–Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena di Milano, Università degli Studi di Milano, Via F. Sforza 35, Milan 20122, Italy, or at gattinon{at}policlinico.mi.it.

Full Text of this Article

Related Letters:

Lung Recruitment in Patients with ARDS
Borges J. B., Carvalho C. R.R., Amato M. B.P., Kacmarek R. M., Villar J., Dixon B., Rouby J.-J., Puybasset L., Lu Q., Gattinoni L., Caironi P., Ranieri V. M.
Extract | Full Text | PDF  
N Engl J Med 2006; 355:319-322, Jul 20, 2006. Correspondence

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