• Claudius A Stahl, Knut Möller, Stefan Schumann, Ralf Kuhlen, Michael Sydow, Christian Putensen, and Josef Guttmann.
• Department of Anesthesiology and Critical Care Medicine, Albert-Ludwigs-University, Freiburg, Germany.
• Crit. Care Med. 2006 Aug 1;34(8):2090-8.

ObjectivesIt is not clear whether the mechanical properties of the respiratory system assessed under the dynamic condition of mechanical ventilation are equivalent to those assessed under static conditions. We hypothesized that the analyses of dynamic and static respiratory mechanics provide different information in acute respiratory failure.DesignProspective multiple-center study.SettingIntensive care units of eight German university hospitals.PatientsA total of 28 patients with acute lung injury and acute respiratory distress syndrome.InterventionsNone.MeasurementsDynamic respiratory mechanics were determined during ongoing mechanical ventilation with an incremental positive end-expiratory pressure (PEEP) protocol with PEEP steps of 2 cm H2O every ten breaths. Static respiratory mechanics were determined using a low-flow inflation.Main ResultsThe dynamic compliance was lower than the static compliance. The difference between dynamic and static compliance was dependent on alveolar pressure. At an alveolar pressure of 25 cm H2O, dynamic compliance was 29.8 (17.1) mL/cm H2O and static compliance was 59.6 (39.8) mL/cm H2O (median [interquartile range], p < .05). End-inspiratory volumes during the incremental PEEP trial coincided with the static pressure-volume curve, whereas end-expiratory volumes significantly exceeded the static pressure-volume curve. The differences could be attributed to PEEP-related recruitment, accounting for 40.8% (10.3%) of the total volume gain of 1964 (1449) mL during the incremental PEEP trial. Recruited volume per PEEP step increased from 6.4 (46) mL at zero end-expiratory pressure to 145 (91) mL at a PEEP of 20 cm H2O (p < .001). Dynamic compliance decreased at low alveolar pressure while recruitment simultaneously increased. Static mechanics did not allow this differentiation. The decrease in static compliance occurred at higher alveolar pressures compared with the dynamic analysis.ConclusionsExploiting dynamic respiratory mechanics during incremental PEEP, both compliance and recruitment can be assessed simultaneously. Based on these findings, application of dynamic respiratory mechanics as a diagnostic tool in ventilated patients should be more appropriate than using static pressure-volume curves.

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