Lung recruitment during small tidal volume ventilation allows minimal positive end-expiratory pressure without augmenting lung injury

Crit Care Med. 1999 Sep;27(9):1940-5. doi: 10.1097/00003246-199909000-00037.


Objectives: Ventilation with positive end-expiratory pressure (PEEP) above the inflection point (P(inf)) has been shown to reduce lung injury by recruiting previously closed alveolar regions; however, it carries the risk of hyperinflating the lungs. The present study examined the hypothesis that a new strategy of recruiting the lung with a sustained inflation (SI), followed by ventilation with small tidal volumes, would allow the maintenance of low PEEP levels (<P(inf)) without inducing additional lung injury.

Design: Prospective, randomized, controlled ex vivo study.

Setting: An animal laboratory in a university setting.

Subjects: Isolated nonperfused lungs of adult Sprague-Dawley rats.

Interventions: We studied the effect on compliance and lung injury in four groups (n = 10 per group) of lavaged rat lungs. One group (group 1) served as a control; their lungs were inflated at PEEP < P(inf) but not ventilated. The other three groups were ventilated with small tidal volumes (5 to 6 mL/kg) for 2 hrs with the following interventions: group 2, PEEP < P(inf) without SI; group 3, PEEP < P(inf) after a SI to 30 cm H2O for 30 secs; and group 4, PEEP > P(inf).

Measurements and main results: In groups 2 and 4, static compliance decreased after ventilation (p < .01). Histologically, group 2 (PEEP < P(inf) without SI) showed significantly greater injury of small airways, but not of terminal respiratory units, compared with group 1. Group 3 (PEEP < P(inf) after a SI), but not group 4, showed significantly less injury of small airways and terminal respiratory units compared with group 2.

Conclusions: We conclude that small tidal volume ventilation after a recruitment maneuver allows ventilation on the deflation limb of the pressure/volume curve of the lungs at a PEEP < P(inf). This strategy a) minimizes lung injury as well as, or better than, use of PEEP > P(inf), and b) ensures a lower PEEP, which may minimize the detrimental consequences of high lung volume ventilation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analysis of Variance
  • Animals
  • Insufflation
  • Intermittent Positive-Pressure Ventilation / methods*
  • Lung Compliance
  • Positive-Pressure Respiration
  • Prospective Studies
  • Random Allocation
  • Rats
  • Rats, Sprague-Dawley
  • Respiratory Distress Syndrome / pathology
  • Respiratory Distress Syndrome / therapy*
  • Respiratory Mechanics*
  • Total Lung Capacity