Key words Compliance
Springer Online Journal Archives 1860-2000
Abstract Objective: Adaptation of ventilator settings to the individual's respiratory system mechanics requires information about the pressure-volume relationship and the change of compliance which is dependent on inflated volume. Unfortunately, established methods of obtaining this information are invasive and time-consuming, and, therefore, not well suited for clinical routine. We propose a new standardized diagnostic concept based on the recently developed slice method. This multiple linear regression method (MLR) determines volume-dependent respiratory system compliance (CSLICE) within the tidal volume (VT) during ongoing mechanical ventilation. The impact of a ventilator strategy, recommended by a consensus conference, on the course of compliance within VT was investigated in patients with the acute respiratory distress syndrome (ARDS) or acute lung injury (ALI).¶Design: Prospective observational study.¶Setting: Intensive care unit of a university hospital.¶Patients: 14 ARDS patients, 2 patients with ALI.¶Interventions: None.¶Measurements and results: After measurement of flow and airway pressure and calculation of tracheal pressure, CSLICE was determined. The resulting course of CSLICE within VT was estimated using a mathematical algorithm. CSLICE data were compared to those obtained by standard MLR. We found decreasing CSLICE mainly in the upper part of VT in all patients. In 7 patients, we found an additional increasing CSLICE mainly in the lower part of VT.¶Conclusions: CSLICE was not constant in patients with ARDS/ALI whose lungs were ventilated according to consensus conference recommendations. The proposed diagnostic concept may serve as a new tool to obtain a standardized estimation of respiratory system compliance within VT non-invasively without interfering with ongoing mechanical ventilation.
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