Ji. Sznajder et al., VOLUME RECRUITMENT AND OXYGENATION IN PULMONARY-EDEMA - A COMPARISON BETWEEN HFOV AND CMV, Journal of critical care, 13(3), 1998, pp. 126-135
Purpose: In acute lung injury, edema floods alveoli decreasing mean lu
ng volume (MLV) and increasing pulmonary venous admixture (Qva/Qt). We
reasoned that a ventilatory strategy that uses large tidal volumes (V
T) might recruit volume differently than a strategy that uses very sma
ll VT (high-frequency oscillatory ventilation, HFOV) which may require
an inflation maneuver to total lung capacity (TLC) for full recruitme
nt. Materials and Methods: We studied six dogs with pulmonary edema in
duced by oleic acid injury and compared HFOV with conventional mechani
cal ventilation (CMV). Increasing mean airway opening pressure (Pao) f
rom 6 to 14 cm H2O raised MLV from 932 +/- 162 to 1,550 +/- 210 mL and
from 872 +/- 145 to 1,242 +/- 192 mL during CMV and HFOV, respectivel
y, whereas Ova/Qt decreased from 24.1 +/- 8.5 to 9.3 +/- 4.3% and from
42.2 +/- 6.8 to 30.4 +/- 9.3%. We repeated our measurements at a Pao
of 14 cm H2O after an inflation maneuver to TLC. Results: Intlation to
TLC recruited additional lung volume and decreased Qva/Qt further onl
y during HFOV. After an inflation to TLC, we observed a rapid isobaric
volume loss from the deflation limb of the pressure-volume curve duri
ng both CMV and HFOV. Conclusions: We conclude that after oleic acid i
njury in dogs pressure-volume hysteresis has two components: a recruit
able portion associated with gas exchange improvement and a nonrecruit
able portion. At the level of PEEP used in this study (8.5 cm H2O), fu
ll lung recruitment during HFOV required inflation to TLC, whereas dur
ing CMV it was accomplished by the relatively large VT. Copyright (C)
1998 by W.B. Saunders Company.