Introduction: Protective ventilatory strategies have been applied to prevent ventilator-induced lung injury in patients with acute lung injury (ALI). However, adjustment of positive end-expiratory pressure (PEEP) to avoid alveolar de-recruitment and hyperinflation remains difficult. An alternative is to set the PEEP based on minimizing respiratory system elastance (Ers) by titrating PEEP. In the present study we evaluate the distribution of lung aeration (assessed using computed tomography scanning) and the behaviour of Ers in a porcine model of ALI, during a descending PEEP titration manoeuvre with a protective low tidal volume. Methods: PEEP titration (from 26 to 0 cmH₂O, with a tidal volume of 6 to 7 ml/kg) was performed, following a recruitment manoeuvre. At each PEEP, helical computed tomography scans of juxta-diaphragmatic parts of the lower lobes were obtained during end-expiratory and end-inspiratory pauses in six piglets with ALI induced by oleic acid. The distribution of the lung compartments (hyperinflated, normally aerated, poorly aerated and non-aerated areas) was determined and the Ers was estimated on a breath-by-breath basis from the equation of motion of the respiratory system using the least-squares method. Results: Progressive reduction in PEEP from 26 cmH₂O to the PEEP at which the minimum Ers was observed improved poorly aerated areas, with a proportional reduction in hyperinflated areas. Also, the distribution of normally aerated areas remained steady over this interval, with no changes in non-aerated areas. The PEEP at which minimal Ers occurred corresponded to the greatest amount of normally aerated areas, with lesser hyperinflated, and poorly and non-aerated areas. Levels of PEEP below that at which minimal Ers was observed increased poorly and non-aerated areas, with concomitant reductions in normally inflated and hyperinflated areas. Conclusion: The PEEP at which minimal Ers occurred, obtained by descending PEEP titration with a protective low tidal volume, corresponded to the greatest amount of normally aerated areas, with lesser collapsed and hyperinflated areas. The institution of high levels of PEEP reduced poorly aerated areas but enlarged hyperinflated ones. Reduction in PEEP consistently enhanced poorly or non-aerated areas as well as tidal re-aeration. Hence, monitoring respiratory mechanics during a PEEP titration procedure may be a useful adjunct to optimize lung aeration.

Introduction: Atelectasis and distal airway closure are common clinical entities of general anaesthesia. These two phenomena are expected to reduce the ventilation of dependent lung regions and represent major causes of arterial oxygenation impairment in anaesthetic conditions. The behaviour of the elastance of the respiratory system (E_rs), as well as the lung aeration assessed by computed tomography (CT) scan, was evaluated during a descendent positive end-expiratory pressure (PEEP) titration. This work sought to evaluate the potential usefulness of E_rs monitoring to set the PEEP in order to prevent tidal recruitment and hyperinflation of healthy lungs under general anaesthesia. Methods: PEEP titration (from 16 to 0 cmH₂O, tidal volume of 8 ml/kg) was performed, and at each PEEP, CT scans were obtained during end-expiratory and end-inspiratory pauses in six healthy, anaesthetized and paralyzed piglets. The distribution of lung aeration was determined and the tidal re-aeration was calculated as the difference between end-expiratory and end-inspiratory poorly aerated and normally aerated areas. Similarly, tidal hyperinflation was obtained as the difference between end-inspiratory and end-expiratory hyperinflated areas. E_rs was estimated from the equation of motion of the respiratory system during all PEEP titration with the least-squares method. Results: Hyperinflated areas decreased from PEEP 16 to 0 cmH₂O (ranges decreased from 24–62% to 1–7% at end-expiratory pauses and from 44–73% to 4–17% at end-inspiratory pauses) whereas normally aerated areas increased (from 30–66% to 72–83% at end-expiratory pauses and from 19–48% to 73–77% at end-inspiratory pauses). From 16 to 8 cmH₂O, E_rs decreased with a corresponding reduction in tidal hyperinflation. A flat minimum of E_rs was observed from 8 to 4 cmH₂O. For PEEP below 4 cmH₂O, E_rs increased in association with a rise in tidal re-aeration and a flat maximum of the normally aerated areas. Conclusion: In healthy piglets under a descending PEEP protocol, the PEEP at minimum E_rs presented a compromise between maximizing normally aerated areas and minimizing tidal re-aeration and hyperinflation. High levels of PEEP, greater than 8 cmH₂O, reduced tidal re-aeration but increased hyperinflation with a concomitant decrease in normally aerated areas.

Giannella-Neto, A., C. Bellido, R. B. Barbosa, and M. F. Vidal Melo. Design and calibration of unicapillary pneumotachographs. J. Appl. Physiol.84(1): 335–343, 1998.—This study presents a method for design and calibration of unicapillary pneumotachographs for small-animal experiments. The design, based on Poiseuille’s law, defines a set of internal radius and length values that allows for laminar flow, measurable pressure differences, and minimal interference with animal’s respiratory mechanics and gas exchange. A third-order polynomial calibration (Pol) of the pressure-flow relationship was employed and compared with linear calibration (Lin). Tests were done for conditions of ambient pressure (Pam) and positive pressure (Ppos) ventilation at different flow ranges. A physical model designed to match normal and low compliance in rats was used. At normal compliance, Pol provided lower errors than Lin for mixed (1–12 ml/s), mean (4–10 ml/s), and high (8–12 ml/s) flow rate calibrations for both Pam and Ppos inspiratory tests (P < 0.001 for all conditions) and expiratory tests (P < 0.001 for all conditions). At low compliance, they differed significantly with 8.6 ± 4.1% underestimation when Lin at Pam was used in Ppos tests. Ppos calibration, preferably in combination with Pol, should be used in this case to minimize errors (Pol = 0.8 ± 0.5%, Lin = 6.5 ± 4.0%, P < 0.0005). Nonlinear calibration may be useful for improvement of flow and volume measurements in small animals during both Pam and Ppos ventilation.