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(Chest. 2002;121:1595-1601.)
© 2002 American College of Chest Physicians

Safety of Pressure-Volume Curve Measurement in Acute Lung Injury and ARDS Using a Syringe Technique*

Warren L. Lee, MD; Thomas E. Stewart, MD; Rod MacDonald, RRCP; Stephen Lapinsky, MD; David Banayan; David Hallett, MSc and Sangeeta Mehta, MD

* From the InterDepartmental Critical Care Medicine Division (Drs. Lee and Stewart) and the Department of Medicine, Division of Respirology (Drs. Mehta and Lapinsky), University of Toronto; and Mount Sinai Hospital (Mr. MacDonald, Mr. Banayan, and Mr. Hallet), Toronto, ON, Canada.

Correspondence to: Sangeeta Mehta, MD, Mount Sinai Hospital, 600 University Ave, Suite 1818, Toronto, ON M5G 1X5, Canada; e-mail: geeta.mehta{at}utoronto.ca

Study objectives: To assess the safety of frequent pressure-volume (PV) curve measurement in patients with acute lung injury (ALI)/ARDS.

Design: Prospective observational study.

Setting: Academic medical-surgical critical care unit.

Patients: Consecutive patients with ALI or ARDS.

Interventions: Static inspiratory PV curves of the respiratory system were determined twice on day 1, then once daily for up to 6 days using a syringe. At each time point, three separate measurements of the PV curve were made. A 100-mL graduated syringe was used to inflate patients’ lungs with 50- to 100-mL increments up to an airway pressure of 45 cm H2O or a total volume of 2 L; each volume step was maintained for 2 to 3 s until a plateau airway pressure was recorded. Outcome measures were mean arterial BP, heart rate (HR), and oxyhemoglobin saturation (SpO2) prior to and immediately after PV curve measurement. There were a priori criteria for procedure discontinuation if poorly tolerated.

Measurements and results: Eleven patients were enrolled with a total of 134 PV curves generated. SpO2 was 93 ± 4% (mean ± SD) before and fell to a nadir of 89 ± 5% during PV curve measurement (p < 0.001), but increased to 97 ± 4% immediately afterwards (p < 0.001, before vs after). HR rose from 106 ± 22 to 108 ± 22 beats/min immediately after the maneuver (p < 0.001). Mean arterial BP was 93 ± 15 mm Hg before and 100 ± 17 mm Hg immediately afterwards (p < 0.001). During PV curve measurement, systolic BP in one patient fell to 64 mm Hg from 113 mm Hg; in another patient, SpO2 dropped to 79% from 89%. Both changes were transient. The study was discontinued in one patient because of inability to tolerate zero positive end-expiratory pressure; in another patient, the study was discontinued because of the development of subcutaneous emphysema.

Conclusions: PV curve measurement by syringe technique is well tolerated in most patients. Nonetheless, the maneuver may cause significant changes in oxygenation and/or hemodynamics, necessitating close monitoring.

Key Words: acute lung injury • ARDS • mechanical ventilation • static pressure-volume curve






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