The effects of low tidal ventilation on lung strain correlate with respiratory system compliance

Jianfeng Xie, Fang Jin, Chun Pan, Songqiao Liu, Ling Liu, Jingyuan Xu, Yi Yang, Haibo Qiu, Jianfeng Xie, Fang Jin, Chun Pan, Songqiao Liu, Ling Liu, Jingyuan Xu, Yi Yang, Haibo Qiu

Abstract

Background: The effect of alterations in tidal volume on mortality of acute respiratory distress syndrome (ARDS) is determined by respiratory system compliance. We aimed to investigate the effects of different tidal volumes on lung strain in ARDS patients who had various levels of respiratory system compliance.

Methods: Nineteen patients were divided into high (Chigh group) and low (Clow group) respiratory system compliance groups based on their respiratory system compliance values. We defined compliance ≥0.6 ml/(cmH2O/kg) as Chigh and compliance <0.6 ml/(cmH2O/kg) as Clow. End-expiratory lung volumes (EELV) at various tidal volumes were measured by nitrogen wash-in/washout. Lung strain was calculated as the ratio between tidal volume and EELV. The primary outcome was that lung strain is a function of tidal volume in patients with various levels of respiratory system compliance.

Results: The mean baseline EELV, strain and respiratory system compliance values were 1873 ml, 0.31 and 0.65 ml/(cmH2O/kg), respectively; differences in all of these parameters were statistically significant between the two groups. For all participants, a positive correlation was found between the respiratory system compliance and EELV (R = 0.488, p = 0.034). Driving pressure and strain increased together as the tidal volume increased from 6 ml/kg predicted body weight (PBW) to 12 ml/kg PBW. Compared to the Chigh ARDS patients, the driving pressure was significantly higher in the Clow patients at each tidal volume. Similar effects of lung strain were found for tidal volumes of 6 and 8 ml/kg PBW. The "lung injury" limits for driving pressure and lung strain were much easier to exceed with increases in the tidal volume in Clow patients.

Conclusions: Respiratory system compliance affected the relationships between tidal volume and driving pressure and lung strain in ARDS patients. These results showed that increasing tidal volume induced lung injury more easily in patients with low respiratory system compliance.

Trial registration: Clinicaltrials.gov identifier NCT01864668 , Registered 21 May 2013.

Keywords: Acute respiratory distress syndrome; Lung strain; Mechanical ventilation; Tidal volume; Ventilator-induced lung injury.

Figures

Fig. 1
Fig. 1
The correlation between compliance and EELV values during mechanical ventilation at the basic tidal volume setting in all included patients. Abbreviations: EELV end-expiratory lung volume
Fig. 2
Fig. 2
The driving pressure in the patients at each tidal volume. *p < 0.001 for the comparison with VT = 6 ml/kg in Chigh group. $p < 0.001 for the comparison with VT = 6 ml/kg in the Clow group. #p < 0.001 for the comparison with the Clow group patients
Fig. 3
Fig. 3
The strain in the patients at each tidal volume. *p < 0.05 for the comparison with the subjects at VT = 6 ml/kg subjects. #p < 0.05 for the comparison with the Clow group patients
Fig. 4
Fig. 4
a The lung strain at different levels of driving pressure. b The correlation between strain and driving pressure. *p < 0.05 for the comparison with driving pressure less than 13 cmH2O. #p < 0.05 for the comparison with patients with driving pressure less than 9 cmH2O

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