Definition and clinical evaluation of a recruiting airway pressure based on the specific lung elastance in...

To determine the specific lung elastance (SE_L) in anesthetized dogs and to evaluate the efficacy of a SE_L-based recruiting airway pressure (RP_aw) at improving global and regional lung aeration.

Retrospective and prospective clinical study.

A total of 28 adult dogs were included in the retrospective study and six adult dogs in the prospective study.

Retrospective study: SE_L and SE_L-based RP_aw were determined using previously published data. In mechanically ventilated dogs undergoing thoracic computed tomography (CT), SE_L was calculated as ΔP_L/(V_T/EELV), where ΔP_L is the driving transpulmonary pressure, V_T is the tidal volume and EELV is the end-expiratory lung volume. The ratio of lung to respiratory system elastance (E_L/E_rs) was determined. SE_L and E_L/E_rs were used to calculate the SE_L-based RP_aw. Prospective study: dogs underwent thoracic CT at end-expiration and at end-inspiration using the SE_L-based RP_aw, and global and regional aeration was determined. For analysis of regional aeration, lungs were divided into cranial, intermediate and caudal regions. Regional compliance was also calculated. A p value <0.05 was considered significant.

The SE_L and E_L/E_rs were 12.7 ± 3.1 cmH₂O and 0.54 ± 0.07, respectively. The SE_L-based RP_aw was 29.1 ± 7.6 cmH₂O. In the prospective study, the RP_aw was 28.2 ± 1.3 cmH₂O. During RP_aw, hyperinflation increased (p = 0.0003) whereas poorly aerated (p < 0.0001) and nonaerated (p = 0.01) tissue decreased. Normally aerated tissue did not change (p = 0.265). Regional compliance was higher in the intermediate (p = 0.0003) and caudal (p = 0.034) regions compared with the cranial region. Aeration did not differ between regions (p > 0.05).

An SE_L-based RP_aw reduces poorly and nonaerated lung tissue in anesthetized dogs. In nonsurgical anesthetized dogs, an RP_aw near 30 cmH₂O is effective at improving lung aeration.