Lung Recruitment in Patients with the Acute Respiratory Distress Syndrome

Lung Recruitment in Patients with the Acute Respiratory Distress SyndromeThe new england journal of medicine established in 1812 april 27, 2006 vol. 354 no. 17

Luciano Gattinoni, M.D., F.R.C.P., Pietro Caironi, M.D., Massimo Cressoni, M.D., Davide Chiumello, M.D., V. Marco Ranieri, M.D., Michael Quintel, M.D., Ph.D., Sebastiano Russo, M.D., Nicol Patroniti, M.D., Rodrigo Cornejo, M.D., and Guillermo Bugedo, M.D.Abstract

The new engl and jour nal of medicine lung recruitment in patients with the acute respiratory distress syndrome

n engl j med 354;17 www.nejm.org april 27, 20061775The New England Journal of Medicine Downloaded from nejm.org on September 6, 2015. For personal use only. No other uses without permission. Copyright 2006 Massachusetts Medical Society. All rights reserved. 1778n engl j med 354;17 www.nejm.org april 27 , 2006 The New England Journal of Medicine Downloaded from nejm.org on September 6, 2015. For personal use only. No other uses without permission. Copyright 2006 Massachusetts Medical Society. All rights reserved. n engl j med 354;17 www.nejm.org april 27, 20061779The New England Journal of Medicine Downloaded from nejm.org on September 6, 2015. For personal use only. No other uses without permission. Copyright 2006 Massachusetts Medical Society. All rights reserved. BackgroundIn the acute respiratory distress syndrome (ARDS), positive end-expiratory pressure (PEEP) may decrease ventilator-induced lung injury by keeping lung regions open that otherwise would be collapsed. Since the effects of PEEP probably depend on the recruitability of lung tissue, we conducted a study to examine the relationship between the percentage of potentially recruitable lung, as indicated by computed tomography (CT), and the clinical and physiological effects of PEEP.MethodsSixty-eight patients with acute lung injury or ARDS underwent whole-lung CT during breath-holding sessions at airway pressures of 5, 15, and 45 cm of water. The percentage of potentially recruitable lung was defined as the proportion of lung tissue in which aeration was restored at airway pressures between 5 and 45 cm of water.ResultsThe percentage of potentially recruitable lung varied widely in the population, accounting for a mean (SD) of 1311 percent of the lung weight, and was highly correlated with the percentage of lung tissue in which aeration was maintained after the application of PEEP (r2 = 0.72, P