Journal of Critical Care
Volume 27, Issue 3 , Pages 323.e11-323.e18, June 2012

Regional lung opening and closing pressures in patients with acute lung injury☆

  • Sven Pulletz, MD

      Affiliations

    • Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
    • Corresponding Author InformationCorresponding author. Tel.: +49 431 597 2991; fax: +49 431 597 3002.
    • ,
  • Andy Adler

      Affiliations

    • Systems and Computer Engineering Carleton University, Ottawa, Canada
    • ,
  • Matthias Kott, MD

      Affiliations

    • Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
    • ,
  • Gunnar Elke, MD

      Affiliations

    • Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
    • ,
  • Barbara Gawelczyk, MD

      Affiliations

    • Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
    • ,
  • Dirk Schädler, MD

      Affiliations

    • Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
    • ,
  • Günther Zick, MD

      Affiliations

    • Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
    • ,
  • Norbert Weiler, MD

      Affiliations

    • Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
    • ,
  • Inéz Frerichs, MD

      Affiliations

    • Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany

published online 28 October 2011.

Abstract 

Purpose

In acute lung injury (ALI), the application of positive end-expiratory pressure (PEEP) is known to prevent the alveoli from cyclic collapse and reopening and to homogenize ventilation. The setting of adequate PEEP could be optimized by the knowledge of regional lung opening and closing pressures at the bedside. The aim of our study was to determine regional opening and closing pressures in ventilated patients by electrical impedance tomography (EIT).

Materials and Methods

Eight patients with healthy lungs and 18 patients with ALI were studied. A low-flow inflation and deflation maneuver with constant gas flow was performed. Regional opening and closing pressures were calculated for every pixel of the EIT scan. These pressures were defined as those values of global airway pressure at which the lung areas opened up or started to close.

Results

Injured lungs exhibited significantly higher regional opening pressures compared with healthy lungs (P < .05). In ALI, significantly higher opening pressures were found in the dependent lung regions. Regional closing pressures did not significantly differ between healthy and injured lungs.

Conclusions

Regional lung opening and closing pressures can be assessed by EIT. This information may facilitate the setting of adequate PEEP levels in patients in future.

Keywords: Acute lung injury, Electrical impedance tomography, EIT, Regional lung opening pressure, Regional lung closing pressure

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☆ Competing interests: Viasys Healthcare reimbursed the fee and the travel costs of Inéz Frerichs to the ESICM and ATS congresses. Norbert Weiler received an unrestricted research grant from CareFusion. The other authors declare that they have no competing interests.

PII: S0883-9441(11)00434-5

doi:10.1016/j.jcrc.2011.09.002

Journal of Critical Care
Volume 27, Issue 3 , Pages 323.e11-323.e18, June 2012

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