Chest, Vol 73, 158-162, Copyright © 1978 by American College of Chest Physicians

ARTICLES

Effect of tidal volume and positive end-expiratory pressure on compliance during mechanical ventilation

PM Suter, HB Fairley and MD Isenberg

In 12 patients requiring therapy with mechanical ventilation for acute respiratory failure, total static compliance (Cst) increased from 29 +/- 4 ml/cm H2O at a tidal volume (TV) of 5 ml/kg to 42 +/- 7 ml/cm H2O at a TV of 15 ml/kg. Similarly, Cst increased from 42 +/- 7 ml/cm H2O to 52 +/- 8 ml/cm H2O between 0 and 6 cm H2O of positive end-expiratory pressure (PEEP). At high levels of pulmonary inflation (ie, high PEEP and large TV) compliance decreased. The changes of total respiratory compliance with TV were mainly due to changes in pulmonary compliance. With PEEP, the functional residual capacity increased, and specific compliance did not change. Two mechanisms may be responsible for the changes in compliance. First, varying TV or PEEP will alter the position of tidal ventilation on the pressure-volume curve, resulting in an increase in compliance with increasing TV and PEEP up to a point, where overdistention occurs and compliance decreases. Secondly, the function of the surface-lowering substance may be altered in acute pulmonary parenchymal disease, thus disturbing the regulation of surface tension over the range of pulmonary inflation studied.

This article has been cited by other articles:

				S.M. Maggiore, J-C. Richard, and L. Brochard What has been learnt from P/V curves in patients with acute lung injury/acute respiratory distress syndrome Eur. Respir. J., August 1, 2003; 22(42_suppl): 22s - 26s. [Abstract] [Full Text] [PDF]

				J. M. Halter, J. M. Steinberg, H. J. Schiller, M. DaSilva, L. A. Gatto, S. Landas, and G. F. Nieman Positive End-Expiratory Pressure after a Recruitment Maneuver Prevents Both Alveolar Collapse and Recruitment/Derecruitment Am. J. Respir. Crit. Care Med., June 15, 2003; 167(12): 1620 - 1626. [Abstract] [Full Text] [PDF]

				W. L. Lee, T. E. Stewart, R. MacDonald, S. Lapinsky, D. Banayan, D. Hallett, and S. Mehta Safety of Pressure-Volume Curve Measurement in Acute Lung Injury and ARDS Using a Syringe Technique* Chest, May 1, 2002; 121(5): 1595 - 1601. [Abstract] [Full Text] [PDF]

				L. GATTINONI, P. CAIRONI, P. PELOSI, and L. R. GOODMAN What Has Computed Tomography Taught Us about the Acute Respiratory Distress Syndrome? Am. J. Respir. Crit. Care Med., November 1, 2001; 164(9): 1701 - 1711. [Full Text] [PDF]

				E. De Robertis, J.M. Liu, S. Blomquist, P.L. Dahm, J. Thorne, and B. Jonson Elastic properties of the lung and the chest wall in young and adult healthy pigs Eur. Respir. J., April 1, 2001; 17(4): 703 - 711. [Abstract] [Full Text] [PDF]

				V. NÈVE, E. D. de la ROQUE, F. LECLERC, S. LETEURTRE, A. DORKENOO, A. SADIK, R. CREMER, and R. LOGIER Ventilator-induced Overdistension in Children . Dynamic versus Low-flow Inflation Volume-Pressure Curves Am. J. Respir. Crit. Care Med., July 1, 2000; 162(1): 139 - 147. [Abstract] [Full Text]

				R. H. KALLET, R. M. JASMER, J. M. LUCE, L. H. LIN, and J. D. MARKS The Treatment of Acidosis in Acute Lung Injury with Tris-Hydroxymethyl Aminomethane (THAM) Am. J. Respir. Crit. Care Med., April 1, 2000; 161(4): 1149 - 1153. [Abstract] [Full Text]

				T. G. Janz, R. Madan, J. J. Marini, W. R. Summer, G. U. Meduri, R. M. Smith, G. R. Epler, and J. Schnader Clinical Conference on Management Dilemmas: Progressive Infiltrates and Respiratory Failure Chest, February 1, 2000; 117(2): 562 - 572. [Full Text] [PDF]

				J. M. Manaligod, E. M. Bendel-Stenzel, P. A. Meyers, D. R. Bing, J. E. Connett, and M. C. Mammel Variations in End-Expiratory Pressure During Partial Liquid Ventilation* : Impact on Gas Exchange, Lung Compliance, and End-Expiratory Lung Volume Chest, January 1, 2000; 117(1): 184 - 190. [Abstract] [Full Text] [PDF]

				B. JONSON, J.-C. RICHARD, C. STRAUS, J. MANCEBO, F. LEMAIRE, and L. BROCHARD Pressure-Volume Curves and Compliance in Acute Lung Injury . Evidence of Recruitment Above the Lower Inflection Point Am. J. Respir. Crit. Care Med., April 1, 1999; 159(4): 1172 - 1178. [Abstract] [Full Text] [PDF]

				B. Jonson and C. Svantesson Elastic pressure-volume curves: what information do they convey? Thorax, January 1, 1999; 54(1): 82 - 87. [Full Text]

				L. GATTINONI, P. PELOSI, P. M. SUTER, A. PEDOTO, P. VERCESI, and A. LISSONI Acute Respiratory Distress Syndrome Caused by Pulmonary and Extrapulmonary Disease . Different Syndromes? Am. J. Respir. Crit. Care Med., July 1, 1998; 158(1): 3 - 11. [Abstract] [Full Text] [PDF]

				M. Kalenga, O. Battisti, A. Francois, J.-P. Langhendries, D. R. Gerstmann, and J.-M. Bertrand High-frequency oscillatory ventilation in neonatal RDS: initial volume optimization and respiratory mechanics J Appl Physiol, April 1, 1998; 84(4): 1174 - 1177. [Abstract] [Full Text] [PDF]

				A. ARTIGAS, G. R. BERNARD, J. CARLET, D. DREYFUSS, L. GATTINONI, L. HUDSON, M. LAMY, J. J. MARINI, M. A. MATTHAY, M. R. PINSKY, et al. The American-European Consensus Conference on ARDS, Part 2 . Ventilatory, Pharmacologic, Supportive Therapy, Study Design Strategies, and Issues Related to Recovery and Remodeling Am. J. Respir. Crit. Care Med., April 1, 1998; 157(4): 1332 - 1347. [Abstract] [Full Text] [PDF]

				V. M. RANIERI, N. BRIENZA, S. SANTOSTASI, F. PUNTILLO, L. MASCIA, N. VITALE, R. GIULIANI, V. MEMEO, F. BRUNO, T. FIORE, et al. Impairment of Lung and Chest Wall Mechanics in Patients with Acute Respiratory Distress Syndrome . Role of Abdominal Distension Am. J. Respir. Crit. Care Med., October 1, 1997; 156(4): 1082 - 1091. [Abstract] [Full Text] [PDF]