ArticleIntensive care medicine experimental2015
Alveolar instability (atelectrauma) is not identified by arterial oxygenation predisposing the development of an occult ventilator-induced lung injury.
Article in Intensive care medicine experimental, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
18 citing papers in PubMed, 21 citations in OpenAlex.
- Determinants of tidal recruitment/derecruitment assessed by electrical impedance tomography in spontaneously breathing acute respiratory distress syndrome patients.American journal of respiratory and critical care medicine · 2026Article
- First Stabilize and then Gradually Recruit: A Paradigm Shift in Protective Mechanical Ventilation for Acute Lung Injury.Journal of clinical medicine · 2023Review
- Myths and Misconceptions of Airway Pressure Release Ventilation: Getting Past the Noise and on to the Signal.Frontiers in physiology · 2022Review
- Impact of Different Positive End-Expiratory Pressures on Lung Mechanics in the Setting of Moderately Elevated Intra-Abdominal Pressure and Acute Lung Injury in a Porcine Model.Journal of clinical medicine · 2021Article
- Different Tidal Volumes May Jeopardize Pulmonary Redox and Inflammatory Status in Healthy Rats Undergoing Mechanical Ventilation.Oxidative medicine and cellular longevity · 2021Article
- Prospective Observational Study to Evaluate the Effect of Different Levels of Positive End-Expiratory Pressure on Lung Mechanics in Patients with and without Acute Respiratory Distress Syndrome.Journal of clinical medicine · 2020Article
- Prevention and treatment of acute lung injury with time-controlled adaptive ventilation: physiologically informed modification of airway pressure release ventilation.Annals of intensive care · 2020Review
- A Physiologically Informed Strategy to Effectively Open, Stabilize, and Protect the Acutely Injured Lung.Frontiers in physiology · 2020Review
- Mechanical Ventilation Lessons Learned From Alveolar Micromechanics.Frontiers in physiology · 2020Review
- Ventilation and Perfusion at the Alveolar Level: Insights From Lung Intravital Microscopy.Frontiers in physiology · 2020Review
- Alveolar dynamics during mechanical ventilation in the healthy and injured lung.Intensive care medicine experimental · 2019Review
- Preemptive Mechanical Ventilation Based on Dynamic Physiology in the Alveolar Microenvironment: Novel Considerations of Time-Dependent Properties of the Respiratory System.The journal of trauma and acute care surgery · 2018Review
- Biomedical engineer's guide to the clinical aspects of intensive care mechanical ventilation.Biomedical engineering online · 2018Review
- Acute lung injury: how to stabilize a broken lung.Critical care (London, England) · 2018Article
- Patient-specific optimization of mechanical ventilation for patients with acute respiratory distress syndrome using quasi-static pulmonary P-V data.Informatics in medicine unlocked · 2018Article
- The Basic Science and Molecular Mechanisms of Lung Injury and Acute Respiratory Distress Syndrome.International anesthesiology clinics · 2018Review
- Personalizing mechanical ventilation according to physiologic parameters to stabilize alveoli and minimize ventilator induced lung injury (VILI).Intensive care medicine experimental · 2017Review
- Physiology in Medicine: Understanding dynamic alveolar physiology to minimize ventilator-induced lung injury.Journal of applied physiology (Bethesda, Md. : 1985) · 2017Review
Corrections and comments
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundImproperly set mechanical ventilation (MV) with normal lungs can advance lung injury and increase the incidence of acute respiratory distress syndrome (ARDS). A key mechanism of ventilator-induced lung injury (VILI) is an alteration in alveolar mechanics including alveolar instability or recruitment/derecruitment (R/D). We hypothesize that R/D cannot be identified by PaO2 (masking occult VILI), and if protective ventilation is not applied, ARDS incidence will increase.
methodsSprague-Dawley rats (n = 8) were anesthetized, surgically instrumented, and placed on MV. A thoracotomy was performed and an in vivo microscope attached to the pleural surface of the lung with baseline dynamic changes in alveolar size during MV recorded. Alveolar instability was induced by intra-tracheal instillation of Tween and alveolar R/D identified as a marked change in alveolar size from inspiration to expiration with increases in positive end-expiratory pressure (PEEP) levels.
resultsDespite maintaining a clinically acceptable PaO2 (55-80 mmHg), the alveoli remained unstable with significant R/D at low PEEP levels. Although PaO2 consistently increased with an increase in PEEP, R/D did not plateau until PEEP was >9 cmH2O.
conclusionsPaO2 remained clinically acceptable while alveolar instability persisted at all levels of PEEP (especially PEEP <9 cmH2O). Therefore, PaO2 levels cannot be used reliably to guide protective MV strategies or infer that VILI is not occurring. Using PaO2 to set a PEEP level necessary to stabilize the alveoli could underestimate the potential for VILI. These findings highlight the need for more accurate marker(s) of alveolar stability to guide protective MV necessary to prevent VILI.
Identifiers
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.