Effect of positive end-expiratory pressure and tidal volume on lung injury induced by alveolar instability.docVIP

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Effect of positive end-expiratory pressure and tidal volume on lung injury induced by alveolar instability.doc

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Effect of positive end-expiratory pressure and tidal volume on lung injury induced by alveolar instability

Available online /content/11/1/R20 Research Open Access Vol 11 No 1 Effect of positive end-expiratory pressure and tidal volume on lung injury induced by alveolar instability Jeffrey M Halter1, Jay M Steinberg1, Louis A Gatto2, Joseph D DiRocco1, Lucio A Pavone1, Henry J Schiller3, Scott Albert1, Hsi-Ming Lee4, David Carney5 and Gary F Nieman1 1Department of Surgery, SUNY Upstate Medical University, E Adams St, Syracuse, New York 13210, USA 2Department of Biological Sciences, SUNY Cortland, Graham Avenue, Cortland, New York 13045, USA 3Department of Surgery, Mayo Clinic, 1st Street SW, Rochester, Minnesota 55905, USA 4Department of Oral Biology and Pathology, SUNY Stonybrook, School of Dental Medicine – South Campus, Stonybrook, New York 11794, USA 5Savannah Pediatric Surgery Department, Memorial Health University Medical Center, Waters Avenue, Savannah, Georgia 31404, USA Corresponding author: Gary F Nieman, niemang@ Received: 2 Oct 2006 Revisions requested: 25 Oct 2006 Revisions received: 24 Jan 2007 Accepted: 15 Feb 2007 Published: 15 Feb 2007 Critical Care 2007, 11:R20 (doi:10.1186/cc5695) This article is online at: /content/11/1/R20 ? 2007 Halter et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Introduction One potential mechanism of ventilator-induced lung injury (VILI) is due to shear stresses associated with alveolar instability (recruitment/derecruitment). It has been postulated that the optimal combination of tidal volume (Vt) and positive end-expiratory pressure (PEEP) stabilizes alveoli, thus diminishing recruitment/derecruitment and reducing VILI. In this study we directly visualized the effect of Vt and PEEP on alveolar mechanics and correlated alveolar stability with lung injur