Definition of optimal PEEP by dynamic compliance after lung recruitment maneuver in canine ARDS model

Medical Journal of Chinese People's Liberation Army. 2012;37(5):389-392


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Journal Title: Medical Journal of Chinese People's Liberation Army

ISSN: 0577-7402 (Print)

Publisher: Editorial Board of Medical Journal of Chinese People's Liberation Army

Society/Institution: Department of Health, Chinese People's Liberation Army

LCC Subject Category: Medicine: Medicine (General)

Country of publisher: China

Language of fulltext: Chinese

Full-text formats available: PDF



Liang PAN
Fei-hu ZHOU
Hong-jun KANG


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Time From Submission to Publication: 18 weeks


Abstract | Full Text

Objective  To investigate the correlation between the optimal lung oxygenation and dynamic lung compliance (Cdyn) during positive end-expiratory pressure (PEEP) titration after lung recruitment maneuver, and explore the method for determining the optimal PEEP titration by Cdyn. Methods  ARDS model was reproduced by intravenous injection of oleic acid into anesthetized dogs. Lung recruitment maneuver was performed by pressure-controlled ventilation (PCV). The PEEP titration was started from 24cmH2O (T24), and it was decreased by 2cmH2O every 10 minutes. After reaching 6cmH2O (T6) for 10 minutes, the PEEP was immediately adjusted to 0cmH2O (T0). Airway peak pressure (Ppeak), Cdyn and end-inspiratory pressure (EIP) were continually measured by Servo-i monitor, and the variation trends were observed with Open Lung Tool software. At the end of each stage, arterial blood was drawn for blood gas analysis, and static lung compliance was measured using inspiratory and expiratory pause manner. The PEEP at the time of beginning of lung collapse was defined as > 10% decrease of oxygenation index. Results  In all the 6 dogs, when PEEP= 16cmH2O, the oxygenation index decreased by more than 10%. Simultaneously, the lung compliance reached its peak value. This suggested that PEEP at this moment indicated the beginning of lung collapse. Therefore, the optimal PEEP should be 16cmH2O plus 2cmH2O, namely 18cmH2O. Conclusion  During the titration of PEEP after lung recruitment maneuver, the beginning of lung collapse could be inferred from the Cdyn, thereby determining the optimal PEEP.