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Curr Opin Anaesthesiol. 2006 Dec;19(6):650-4.

Alveolar recruitment versus hyperinflation: A balancing act.

Author information

1
Department of Anesthesiology, University of California, San Diego, California, USA. rdueck@ucsd.edu

Abstract

PURPOSE OF REVIEW:

To address lung recruitment according to pressure/volume curves, along with regional recruitment versus hyperinflation evidence from computed tomography and electrical impedance tomography.

RECENT FINDINGS:

Cyclical tidal volume recruitment of atelectatic lung regions causes acute lung injury, as do large breaths during pneumonectomy. Using the lower inflection point on the static pressure/volume inflation curve plus 2 cmH2O as a positive end-expiratory pressure setting limits hyperinflation in acute lung injury, but may not provide enough positive end-expiratory pressure to avoid cyclical recruitment/derecruitment injury in more severe acute lung injury regions. Both computed tomography and electrical impedance tomography can help titrate positive end-expiratory pressure in these regions, thereby assuring an 'open lung' ventilatory pattern. Regional pressure/volume curves show that adequate positive end-expiratory pressure for severe acute lung injury regions may not be reliably determined from whole lung pressure/volume curves. Balancing positive end-expiratory pressure requires both arterial PO2 and PCO2 values to determine at what level hyperinflated regions become seriously underperfused (develop very high ventilation-perfusion ratios), adding to the hypercarbia from increased deadspace.

SUMMARY:

Positive end-expiratory pressure levels must be high enough to minimize recruitment/derecruitment cycling. Balancing recruitment versus overdistension may require thoracic tomography, to assure sufficient improvement in oxygenation while limiting hypercarbia.

PMID:
17093370
DOI:
10.1097/ACO.0b013e328011015d
[Indexed for MEDLINE]
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