Lung recruitability determines the impact of PEEP on mechanical power in ARDS
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Le résumé fourni par la source
Mechanical power increases with positive end-expiratory pressure (PEEP). However, its injurious potential may depend on the available lung gas volume, which can be modified by alveolar recruitment. We investigated how PEEP-induced recruitment affects mechanical power. We analyzed previously collected data on 20 patients with acute respiratory distress syndrome who underwent a decremental PEEP trial (15–5 cmH₂O). End-expiratory lung volume and respiratory mechanics were measured to quantify recruited volume, functional residual capacity (FRC), and the recruitment-to-inflation (R/I) ratio. Absolute power and power normalized to aerated lung volume (FRC + recruited volume) were calculated at each PEEP level. Patients were classified as having higher or lower recruitability according to the cohort median recruited volume accrued between PEEP 5 and 15 cmH₂O, expressed as a fraction of FRC (median 0.42). Absolute mechanical power increased linearly with rising PEEP (approximately + 1 J/min per cmH₂O), from 20 [16–23] J/min at 5 cmH₂O, to 31 [28–33] J/min at 15 cmH₂O, irrespective of recruitability (low recruitability: + 1.12 J/min per cmH₂O, p < 0.001; high recruitability: + 0.96 J/min per cmH₂O, p < 0.001, p for interaction = 0.12). Normalized power increased in patients with lower recruitability (+ 0.43 J/min/L per cmH 2 O, p < 0.001) but decreased in those with higher recruitability (− 0.33 J/min/L per cmH 2 O, p < 0.001; p for interaction < 0.001). The reduction in normalized power was strongly related to PEEP-induced recruitment, expressed as recruited volume/FRC (− 102% per unit, R 2 = 0.75, p < 0.001), and to R/I ratio (− 38% per unit, R 2 = 0.69, p < 0.001). Associations with PEEP-related changes in compliance (R 2 = 0.40, p = 0.003) and PaO₂/FiO₂ (R 2 = 0.33, p = 0.008) were weaker. In the multivariate model, PEEP-induced recruitment (p = 0.002) and compliance changes (p = 0.011) remained independent predictors of normalized power changes. Absolute mechanical power increases with higher PEEP, but power per aerated lung decreases when PEEP produces substantial recruitment. PEEP-induced increases in absolute power do not necessarily imply a higher mechanical load per alveolar unit. Recruited volume and compliance changes are the main physiological determinants of this effect. Among bedside tools, the R/I ratio best identifies whether and to what extent PEEP will reduce or increase mechanical power per alveolar unit.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Lung recruitability determines the impact of PEEP on mechanical power in ARDS
- Date Crossref
- 20/01/2026
- Éditeur
- Springer Science and Business Media LLC
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Università Cattolica del Sacro Cuore pays non établi dans la noticeUniversité ou école supérieure
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Agostino Gemelli University Polyclinic pays non établi dans la noticeÉtablissement de santé
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University of the Sacred Heart Department of Anesthesiology and Intensive Care Medicine pays non établi dans la noticeUniversité ou école supérieure
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University of Turin Department of Surgical Science pays non établi dans la noticeUniversité ou école supérieure
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Istituti di Ricovero e Cura a Carattere Scientifico pays non établi dans la noticeÉtablissement de santé
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Universitätsmedizin Göttingen pays non établi dans la noticeÉtablissement de santé
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Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Department of Anesthesia pays non établi dans la noticeÉtablissement de santé
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Universidade Federal do Rio de Janeiro pays non établi dans la noticeUniversité ou école supérieure
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King's College London pays non établi dans la noticeUniversité ou école supérieure
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Guy's and St Thomas' NHS Foundation Trust pays non établi dans la noticeÉtablissement de santé
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Thomas Foundation pays non établi dans la noticeOrganisation à but non lucratif
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Azienda USL di Bologna pays non établi dans la noticeÉtablissement de santé
Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic et Department of Anesthesiology and Intensive Care Medicine — University of the Sacred Heart, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.