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Recruitment maneuver: RAMP versus CPAP pressure profile in a model of acute lung injury

Authors
Journal
Respiratory Physiology & Neurobiology
1569-9048
Publisher
Elsevier
Publication Date
Volume
169
Issue
1
Identifiers
DOI: 10.1016/j.resp.2009.08.010
Keywords
  • Elastance
  • Extracellular Matrix
  • Transpulmonary Pressure
  • Recruitment Maneuvers
  • Acute Respiratory Distress Syndrome
Disciplines
  • Physics

Abstract

Abstract We examined whether recruitment maneuvers (RMs) with gradual increase in airway pressure (RAMP) provide better outcome than continuous positive airway pressure (CPAP) in paraquat-induced acute lung injury (ALI). Wistar rats received saline intraperitoneally (0.5 mL, CTRL) or paraquat (15 mg/kg, ALI). Twenty-four hours later lung mechanics [static elastance, viscoelastic component of elastance, resistive, viscoelastic and total pressures] were determined before and after recruitment with 40 cmH 2O CPAP for 40 s or 40-s-long slow increase in pressure up to 40 cmH 2O (RAMP) followed by 0 or 5 cmH 2O PEEP. Fractional area of alveolar collapse and PCIII mRNA were determined. All mechanical parameters and the fraction area of alveolar collapse were higher in ALI compared to CTRL. Only RAMP-PEEP maneuver significantly improved lung mechanics and decreased PCIII mRNA expression (53%) compared with ALI, while both RMs followed by PEEP decreased alveolar collapse. In conclusion, in the present experimental ALI model, RAMP followed by 5 cm H 2O PEEP yields a better outcome.

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