Francesco Murgolo, Domenico L Grieco, Savino Spadaro, Nicola Bartolomeo, Rossella di Mussi, Luigi Pisani, Marco Fiorentino, Alberto Maria Crovace, Luca Lacitignola, Francesco Staffieri, Salvatore Grasso
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We hypothesized that R/I may reflect the potential for lung recruitment (i.e. recruitability) and, consequently, estimate the impact of PEEP on dynamic lung strain, both assessed through computed tomography scan.</p><p><strong>Methods: </strong>Fourteen lung-damaged pigs (lipopolysaccharide infusion) underwent ventilation at low (5 cmH<sub>2</sub>O) and high PEEP (i.e., PEEP generating a plateau pressure of 28-30 cmH<sub>2</sub>O). R/I was measured through a one-breath derecruitment maneuver from high to low PEEP. PEEP-induced changes in dynamic lung strain, difference in nonaerated lung tissue weight (tissue recruitment) and amount of gas entering previously nonaerated lung units (gas recruitment) were assessed through computed tomography scan. Tissue and gas recruitment were normalized to the weight and gas volume of previously ventilated lung areas at low PEEP (normalized-tissue recruitment and normalized-gas recruitment, respectively).</p><p><strong>Results: </strong>Between high (median [interquartile range] 20 cmH<sub>2</sub>O [18-21]) and low PEEP, median R/I was 1.08 [0.88-1.82], indicating high lung recruitability. Compared to low PEEP, tissue and gas recruitment at high PEEP were 246 g [182-288] and 385 ml [318-668], respectively. R/I was linearly related to normalized-gas recruitment (r = 0.90; [95% CI 0.71 to 0.97) and normalized-tissue recruitment (r = 0.69; [95% CI 0.25 to 0.89]). Dynamic lung strain was 0.37 [0.29-0.44] at high PEEP and 0.59 [0.46-0.80] at low PEEP (p < 0.001). R/I was significantly related to PEEP-induced reduction in dynamic (r = - 0.93; [95% CI - 0.78 to - 0.98]) and global lung strain (r = - 0.57; [95% CI - 0.05 to - 0.84]). No correlation was found between R/I and and PEEP-induced changes in static lung strain (r = 0.34; [95% CI - 0.23 to 0.74]).</p><p><strong>Conclusions: </strong>In a highly recruitable ARDS model, R/I reflects the potential for lung recruitment and well estimates the extent of PEEP-induced reduction in dynamic lung strain.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"14 1","pages":"106"},"PeriodicalIF":5.7000,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224186/pdf/","citationCount":"0","resultStr":"{\"title\":\"Recruitment-to-inflation ratio reflects the impact of peep on dynamic lung strain in a highly recruitable model of ARDS.\",\"authors\":\"Francesco Murgolo, Domenico L Grieco, Savino Spadaro, Nicola Bartolomeo, Rossella di Mussi, Luigi Pisani, Marco Fiorentino, Alberto Maria Crovace, Luca Lacitignola, Francesco Staffieri, Salvatore Grasso\",\"doi\":\"10.1186/s13613-024-01343-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The recruitment-to-inflation ratio (R/I) has been recently proposed to bedside assess response to PEEP. The impact of PEEP on ventilator-induced lung injury depends on the extent of dynamic strain reduction. We hypothesized that R/I may reflect the potential for lung recruitment (i.e. recruitability) and, consequently, estimate the impact of PEEP on dynamic lung strain, both assessed through computed tomography scan.</p><p><strong>Methods: </strong>Fourteen lung-damaged pigs (lipopolysaccharide infusion) underwent ventilation at low (5 cmH<sub>2</sub>O) and high PEEP (i.e., PEEP generating a plateau pressure of 28-30 cmH<sub>2</sub>O). R/I was measured through a one-breath derecruitment maneuver from high to low PEEP. PEEP-induced changes in dynamic lung strain, difference in nonaerated lung tissue weight (tissue recruitment) and amount of gas entering previously nonaerated lung units (gas recruitment) were assessed through computed tomography scan. Tissue and gas recruitment were normalized to the weight and gas volume of previously ventilated lung areas at low PEEP (normalized-tissue recruitment and normalized-gas recruitment, respectively).</p><p><strong>Results: </strong>Between high (median [interquartile range] 20 cmH<sub>2</sub>O [18-21]) and low PEEP, median R/I was 1.08 [0.88-1.82], indicating high lung recruitability. Compared to low PEEP, tissue and gas recruitment at high PEEP were 246 g [182-288] and 385 ml [318-668], respectively. R/I was linearly related to normalized-gas recruitment (r = 0.90; [95% CI 0.71 to 0.97) and normalized-tissue recruitment (r = 0.69; [95% CI 0.25 to 0.89]). Dynamic lung strain was 0.37 [0.29-0.44] at high PEEP and 0.59 [0.46-0.80] at low PEEP (p < 0.001). R/I was significantly related to PEEP-induced reduction in dynamic (r = - 0.93; [95% CI - 0.78 to - 0.98]) and global lung strain (r = - 0.57; [95% CI - 0.05 to - 0.84]). 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引用次数: 0
摘要
背景：最近有人提出用募集与充气比值（R/I）在床旁评估对 PEEP 的反应。PEEP 对呼吸机诱发的肺损伤的影响取决于动态应变降低的程度。我们假设 R/I 可反映肺募集的潜力（即可募集性），从而估算 PEEP 对肺动态应变的影响，两者均通过计算机断层扫描进行评估：方法：14 头肺损伤猪（脂多糖输注）在低 PEEP（5 cmH2O）和高 PEEP（即产生 28-30 cmH2O 高原压的 PEEP）下进行通气。通过从高 PEEP 到低 PEEP 的单次呼吸减容操作测量 R/I。通过计算机断层扫描评估 PEEP 引起的肺动态应变变化、不通气肺组织重量差异（组织募集）和进入先前不通气肺单位的气体量（气体募集）。在低 PEEP 条件下，将组织和气体吸入量归一化为先前通气肺区的重量和气体体积（分别为归一化组织吸入量和归一化气体吸入量）：结果：在高 PEEP（中位数[四分位数间距] 20 cmH2O [18-21]）和低 PEEP 之间，中位数 R/I 为 1.08 [0.88-1.82]，表明肺的可募集性很高。与低 PEEP 相比，高 PEEP 下的组织和气体募集量分别为 246 克 [182-288] 和 385 毫升 [318-668]。R/I 与归一化气体招募（r = 0.90；[95% CI 0.71 至 0.97]）和归一化组织招募（r = 0.69；[95% CI 0.25 至 0.89]）呈线性关系。高 PEEP 时的肺动态应变为 0.37 [0.29-0.44]，低 PEEP 时的肺动态应变为 0.59 [0.46-0.80]（P 结论）：在高度可募集的 ARDS 模型中，R/I 反映了肺募集的潜力，并很好地估计了 PEEP 诱导的肺动态应变降低的程度。
Recruitment-to-inflation ratio reflects the impact of peep on dynamic lung strain in a highly recruitable model of ARDS.
Background: The recruitment-to-inflation ratio (R/I) has been recently proposed to bedside assess response to PEEP. The impact of PEEP on ventilator-induced lung injury depends on the extent of dynamic strain reduction. We hypothesized that R/I may reflect the potential for lung recruitment (i.e. recruitability) and, consequently, estimate the impact of PEEP on dynamic lung strain, both assessed through computed tomography scan.
Methods: Fourteen lung-damaged pigs (lipopolysaccharide infusion) underwent ventilation at low (5 cmH2O) and high PEEP (i.e., PEEP generating a plateau pressure of 28-30 cmH2O). R/I was measured through a one-breath derecruitment maneuver from high to low PEEP. PEEP-induced changes in dynamic lung strain, difference in nonaerated lung tissue weight (tissue recruitment) and amount of gas entering previously nonaerated lung units (gas recruitment) were assessed through computed tomography scan. Tissue and gas recruitment were normalized to the weight and gas volume of previously ventilated lung areas at low PEEP (normalized-tissue recruitment and normalized-gas recruitment, respectively).
Results: Between high (median [interquartile range] 20 cmH2O [18-21]) and low PEEP, median R/I was 1.08 [0.88-1.82], indicating high lung recruitability. Compared to low PEEP, tissue and gas recruitment at high PEEP were 246 g [182-288] and 385 ml [318-668], respectively. R/I was linearly related to normalized-gas recruitment (r = 0.90; [95% CI 0.71 to 0.97) and normalized-tissue recruitment (r = 0.69; [95% CI 0.25 to 0.89]). Dynamic lung strain was 0.37 [0.29-0.44] at high PEEP and 0.59 [0.46-0.80] at low PEEP (p < 0.001). R/I was significantly related to PEEP-induced reduction in dynamic (r = - 0.93; [95% CI - 0.78 to - 0.98]) and global lung strain (r = - 0.57; [95% CI - 0.05 to - 0.84]). No correlation was found between R/I and and PEEP-induced changes in static lung strain (r = 0.34; [95% CI - 0.23 to 0.74]).
Conclusions: In a highly recruitable ARDS model, R/I reflects the potential for lung recruitment and well estimates the extent of PEEP-induced reduction in dynamic lung strain.
期刊介绍：
Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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