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How to use PEEP-to-plateau curves to detect recruitment / derecruitment in ICU?
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This external validation study confirms the use the cut off value of the 100ml (or 1.4 ml/kg of PBD) of tidal hysteresis for the detection at the bedside of intra-tidal recruitment – a major determinant of ventilator-induced lung injury – and allows fine tuning of PEEP setting in daily life.
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Validation of thresholds for tidal lung hysteresis to detect tidal recruitment/derecruitment in patients with acute respiratory distress syndrome
Francesco Mojoli et al.
Extract
“To the Editor
During a decremental positive end-expiratory pressure (PEEP) trial, insufficient PEEP may lead to expiratory lung collapse followed by inspiratory reopening (tidal recruitment/derecruitment), an injurious mechanism that may misleadingly increase measured respiratory system compliance (Crs), ultimately resulting in setting a PEEP level that does not prevent alveolar instability.1-3 A combined assessment of Crs and tidal hysteresis improves interpretation of the trial, because tidal recruitment/derecruitment is indicated by a large increase in hysteresis following PEEP reduction.1,4 In a previous post hoc analysis among patients with COVID-19 acute respiratory distress syndrome (ARDS), an absolute hysteresis threshold (≥100 mL) predicted tidal recruitment/derecruitment without requiring comparison between different PEEP levels.1 We performed an external validation of this threshold to detect alveolar instability using a single assessment of hysteresis, independently of a PEEP trial. In addition, we sought to identify a cutoff for hysteresis normalized to the patient’s predicted body weight (PBW).”
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