• G Mols, I Brandes, V Kessler, M Lichtwarck-Aschoff, T Loop, K Geiger, and J Guttmann.
• Department of Anesthesiology and Critical Care Medicine, University of Freiburg, Hugstetterstrasse 55, 79106 Freiburg, Germany. mols@ana1.ukl.uni-freiburg.de
• Intensive Care Med. 1999 Oct 1;25(10):1084-91.

ObjectiveAdaptation of ventilator settings to the individual's respiratory system mechanics requires information about the pressure-volume relationship and the change of compliance which is dependent on inflated volume. Unfortunately, established methods of obtaining this information are invasive and time-consuming, and, therefore, not well suited for clinical routine. We propose a new standardized diagnostic concept based on the recently developed slice method. This multiple linear regression method (MLR) determines volume-dependent respiratory system compliance (C(SLICE)) within the tidal volume (V(T)) during ongoing mechanical ventilation. The impact of a ventilator strategy, recommended by a consensus conference, on the course of compliance within V(T) was investigated in patients with the acute respiratory distress syndrome (ARDS) or acute lung injury (ALI).DesignProspective observational study.SettingIntensive care unit of a university hospital.Patients14 ARDS patients, 2 patients with ALI.InterventionsNone.Measurements And ResultsAfter measurement of flow and airway pressure and calculation of tracheal pressure, C(SLICE) was determined. The resulting course of C(SLICE) within V(T) was estimated using a mathematical algorithm. C(SLICE) data were compared to those obtained by standard MLR. We found decreasing C(SLICE) mainly in the upper part of V(T) in all patients. In 7 patients, we found an additional increasing C(SLICE) mainly in the lower part of V(T).ConclusionsC(SLICE) was not constant in patients with ARDS/ALI whose lungs were ventilated according to consensus conference recommendations. The proposed diagnostic concept may serve as a new tool to obtain a standardized estimation of respiratory system compliance within V(T) non-invasively without interfering with ongoing mechanical ventilation.

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