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British Journal of Anaesthesia, 2000, Vol. 85, No. 4 577-586
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia

Static versus dynamic respiratory mechanics for setting the ventilator

M. Lichtwarck-Aschoff1,*, V. Kessler2, U. H. Sjöstrand3, A. Hedlund4, G. Mols2, S. Rubertsson3, A. M. Markström5 and J. Guttmann2

1Department of Anesthesiology and Intensive Care, University Hospital, Uppsala, Sweden and Zentralklinikum Augsburg, Germany. 2Department of Anesthesiology and Critical Care Medicine, University of Freiburg, Freiburg, Germany. 3Department of Anesthesiology and Intensive Care, University Hospital, Uppsala, Sweden. 4Department of Plastic Surgery, University Hospital, Uppsala, Sweden. 5Department of Anesthesiology and Intensive Care and Dept of Otorhinolaryngology University Hospital, Uppsala, Sweden

The lower inflection point (LIP) of the inspiratory limb of a static pressure-volume (PV) loop is assumed to indicate the pressure at which most lung units are recruited. The LIP is determined by a static manoeuvre with a PV-history that is different from the PV-history of the actual ventilation. In nine surfactant-deficient piglets, information to allow setting PEEP and VT was obtained, both from the PV-curve and also during ongoing ventilation from the dynamic compliance relationship. According to LIP, PEEP was set at 20 (95% confidence interval 17–22) cm H2O. Volume-dependent dynamic compliance suggested a PEEP reduction (to 15 (13–18) cm H2O). Pulmonary gas exchange remained satisfactory and this change resulted in reduced mechanical stress on the respiratory system, indirectly indicated by volume-dependent compliance being consistently great during the entire inspiration.

Br J Anaesth 2000; 85: 577–86

* Corresponding author: Klinik für Anaesthesiologie und Operative Intensivmedizin am Zentralklinikum Augsburg, Stenglinstr. 2, D-86156 Augsburg, Germany


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