부산대학교 도서관

Byline: Didier Demory (1), Jean-Michel Arnal (1), Marc Wysocki (2), Stephane Donati (1), Isabelle Granier (1), GaA< Keywords: ALI/ARDS; Mechanical ventilation; Pressure--volume curves; Hysteresis; Recruitment maneuver; Positive end-expiratory pressure Abstract: Objective To assess the hysteresis of the pressure--volume curve (PV curve) as to estimate, easily and at the bedside, the recruitability of the lung in ARDS patients. Design Prospective study. Setting Twelve medico-surgical ICU beds of a general hospital. Patients Twenty-six patients within the first 24 h from meeting ARDS criteria. Intervention A Quasi-static inflation and deflation PV curve from 0 to 40 cm[H.sub.2]O and a 40 cm[H.sub.2]O recruitment maneuver (RM) maintained for 10 s were successively done with an interval of 30 min in between. Recordings and calculation Hysteresis of the PV curve (H .sub.PV) was calculated as the ratio of the area enclosed by the pressure volume loop divided by the predicted body weight (PBW). The volume increase during the RM (V .sub.RM) was measured by integration of the flow required to maintain the pressure at 40 cm[H.sub.2]O and divided by PBW, as an estimation of the volume recruited during the RM. Results A positive linear correlation was found between H .sub.PV and V .sub.RM (r = 0.81, P < 0.0001). Conclusions The results suggest using the hysteresis of the PV curve to assess the recruitability of the lung. Author Affiliation: (1) Service de reanimation polyvalente, Hopital Font Pre, 1208 avenue du colonel Picot, 83100, Toulon, France (2) Department of Medical Research, Hamilton Medical, Bonaduz, Switzerland Article History: Registration Date: 16/05/2008 Received Date: 28/09/2007 Accepted Date: 14/05/2008 Online Date: 25/06/2008 Article note: This study was conducted in the Intensive Care Unit of Font Pre Hospital, Toulon, France.