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Closing Pressure Rather Than Opening Pressure Determines Optimal Positive End-Expiratory Pressure and Avoids Overdistention*

Kevin M. Creamer, MD; Laryssa L. McCloud, PhD; Lyle E. Fisher, MD; Ina C. Ehrhart, PhD
Author and Funding Information

*From the Medical College of Georgia, Vascular Biology Center and Pediatric Critical Care, Augusta, GA.

Correspondence to: Kevin Creamer, MD, Pediatric Critical Care, Children’s Medical Center, 1446 Harper St, Augusta, GA 30912



Chest. 1999;116(suppl_1):26S-27S. doi:10.1378/chest.116.suppl_1.26S
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Extract

Ventilator-induced lung injury can result from either low lung volume ventilation with its associated cyclic alveolar collapse1 or from lung overdistention23 and volutrauma. Positive end-expiratory pressure (PEEP) is the main determinant of end-expiratory lung volume (EELV).4 If PEEP is set too low, alveolar and bronchiolar collapse can occur. Tidal volume in conjunction with PEEP determines end-inspiratory lung volume (EILV), which is a key determinant in volutrauma.5 When PEEP is determined by the inflation limb inflection point, or the “opening pressure” (OP), of the pressure-volume (P-V) curve, it can be used to recruit collapsed alveoli, improving oxygenation as well as compliance.67 However, OP, an inspiratory parameter, may overestimate the least amount of PEEP required to maintain alveolar stability and result in overdistention.8 We decided to look at expiratory parameters to help determine optimal PEEP. We set out to find a mechanical ventilation strategy that would utilize optimal PEEP for alveolar recruitment but not result in overdistention.


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