Protective ventilation in a pig model of acute lung injury: timing is as important as pressure
Harry Ramcharran, Jason H. T. Bates, Joshua Satalin, Sarah J. Blair, Penny L. Andrews, Donald P. Gaver, Louis A. Gatto, Guirong Wang, Auyon Ghosh, Benjamin Robedee, James L. Vossler, Nader M. Habashi, Nirav Daphtary, Michaela Kollisch‐Singule, Gary F. Nieman
Abstract
In a large animal model of ARDS, recruitment/derecruitment caused greater VILI than overdistension, whereas both mechanisms together caused severe lung damage. These findings suggest that eliminating cyclic recruitment and derecruitment during mechanical ventilation should be a preeminent management goal for the patient with ARDS. The airway pressure release ventilation (APRV) mode of mechanical ventilation can achieve this if delivered with an expiratory duration (T Low ) that is brief enough to prevent derecruitment at end expiration.