Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 6/2009

Open Access 01-12-2009 | Research

Pressure-dependent stress relaxation in acute respiratory distress syndrome and healthy lungs: an investigation based on a viscoelastic model

Authors: Steven Ganzert, Knut Möller, Daniel Steinmann, Stefan Schumann, Josef Guttmann

Published in: Critical Care | Issue 6/2009

Login to get access

Abstract

Introduction

Limiting the energy transfer between ventilator and lung is crucial for ventilatory strategy in acute respiratory distress syndrome (ARDS). Part of the energy is transmitted to the viscoelastic tissue components where it is stored or dissipates. In mechanically ventilated patients, viscoelasticity can be investigated by analyzing pulmonary stress relaxation. While stress relaxation processes of the lung have been intensively investigated, non-linear interrelations have not been systematically analyzed, and such analyses have been limited to small volume or pressure ranges. In this study, stress relaxation of mechanically ventilated lungs was investigated, focusing on non-linear dependence on pressure. The range of inspiratory capacity was analyzed up to a plateau pressure of 45 cmH2O.

Methods

Twenty ARDS patients and eleven patients with normal lungs under mechanical ventilation were included. Rapid flow interruptions were repetitively applied using an automated super-syringe maneuver. Viscoelastic resistance, compliance and time constant were determined by multiple regression analysis using a lumped parameter model. This same viscoelastic model was used to investigate the frequency dependence of the respiratory system's impedance.

Results

The viscoelastic time constant was independent of pressure, and it did not differ between normal and ARDS lungs. In contrast, viscoelastic resistance increased non-linearly with pressure (normal: 8.4 (7.4-11.9) [median (lower - upper quartile)] to 35.2 (25.6-39.5) cmH2O·sec/L; ARDS: 11.9 (9.2-22.1) to 73.5 (56.8-98.7)cmH2O·sec/L), and viscoelastic compliance decreased non-linearly with pressure (normal: 130.1(116.9-151.3) to 37.4(34.7-46.3) mL/cmH2O; ARDS: 125.8(80.0-211.0) to 17.1(13.8-24.7)mL/cmH2O). The pulmonary impedance increased with pressure and decreased with respiratory frequency.

Conclusions

Viscoelastic compliance and resistance are highly non-linear with respect to pressure and differ considerably between ARDS and normal lungs. None of these characteristics can be observed for the viscoelastic time constant. From our analysis of viscoelastic properties we cautiously conclude that the energy transfer from the respirator to the lung can be reduced by application of low inspiratory plateau pressures and high respiratory frequencies. This we consider to be potentially lung protective.
Appendix
Available only for authorised users
Literature
1.
Hickling KG, Henderson SJ, Jackson R: Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med 1990, 16: 372-377. 10.1007/BF01735174CrossRefPubMed
2.
Gattinoni L, Pesenti A: The concept of "baby lung". Intensive Care Med 2005, 31: 776-784. 10.1007/s00134-005-2627-zCrossRefPubMed
3.
Dreyfuss D, Saumon G: Ventilator-induced lung injury: lessons from experimental studies. Am J Resp Crit Care Med 1998, 157: 294-323.CrossRefPubMed
4.
The Acute Respiratory Distress Syndrome Network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000, 342: 1301-1308. 10.1056/NEJM200005043421801CrossRef
5.
Stenqvist O, Odenstedt H, Lundin S: Dynamic respiratory mechanics in acute lung injury/acute respiratory distress syndrome: research or clinical tool? Curr Opin Crit Care 2008, 14: 87-93. 10.1097/MCC.0b013e3282f3a166CrossRefPubMed
6.
Hotchkiss JR Jr, Blanch L, Murias G, Adams AB, Olson DA, Wangensteen OD, Leo PH, Marini JJ: Effects of decreased respiratory frequency on ventilator-induced lung injury. Am J Resp Crit Care Med 2000,161(2 Pt 1):463-468.CrossRefPubMed
7.
v Neergaard K, Wirz K: Die Messung der Strömungswiderstände in den Atemwegen des Menschen insbesondere bei Asthma und Emphysem. Z Klin Med Berl 1927, 51-82.
8.
v. Neergaard K, Wirz K: Über die Methode zur Messung der Lungenelastizität am lebenden Menschen, insbesondere beim Emphysem. Z Klin Med Berl 1927, 105: 35-50.
9.
Otis B, Proctor DF: Measurement of Alveolar Pressure in Human Subjects. Am J Physiol 1947, 152: 106-112.
10.
Vuilleumier P: Über eine Methode zur Messung des intraalveolären Druckes und der Strömungswiderstände in den Atemwegen des Menschen. Z Klin Med Berl 1944, 143: 698-717.
11.
Fung YC: Biomechanics. Mechanical Properties of Living Tissues. New York: Springer-Verlag; 1981.
12.
Bates JHT, Baconnier P, Milic-Emili J: A theoretical analysis of interrupter technique for measuring respiratory mechanics. J Appl Physiol 1988, 64: 2204-2214.PubMed
13.
Sharp JT, Johnson FN, Goldberg NB, Van Lith P: Hysteresis and stress adaptation in the human respiratory system. J Appl Physiol 1967, 23: 487-497.PubMed
14.
D'Angelo E, Calderini E, Torri G, Robatto FM, Bono D, Milic-Emili J: Respiratory mechanics in anesthetized paralyzed humans: effects of flow, volume, and time. J Appl Physiol 1989, 67: 2556-2564.PubMed
15.
Eissa NT, Ranieri VM, Corbeil C, Chasse M, Robatto FM, Braidy J, Milic-Emili J: Analysis of behavior of the respiratory system in ARDS patients: effects of flow, volume, and time. J Appl Physiol 1991, 70: 2719-2729. 10.1063/1.349386CrossRefPubMed
16.
Pesenti A, Pelosi P, Rossi N, Virtuani A, Brazzi L, Rossi A: The effects of positive end-expiratory pressure on respiratory resistance in patients with the adult respiratory distress syndrome and in normal anesthetized subjects. Am Rev Resp Dis 1991, 144: 101-107.CrossRefPubMed
17.
D'Angelo E, Calderini E, Tavola M, Bono D, Milic-Emili J: Effect of PEEP on respiratory mechanics in anesthetized paralyzed humans. J Appl Physiol 1992, 73: 1736-1742.PubMed
18.
Eissa NT, Ranieri VM, Corbeil C, Chasse M, Braidy J, Milic-Emili J: Effect of PEEP on the mechanics of the respiratory system in ARDS patients. J Appl Physiol 1992, 73: 1728-1735.PubMed
19.
Jonson B, Beydon L, Brauer K, Mansson C, Valind S, Grytzell H: Mechanics of respiratory system in healthy anesthetized humans with emphasis on viscoelastic properties. J Appl Physiol 1993, 75: 132-140.PubMed
20.
Pelosi P, Cereda M, Foti G, Giacomini M, Pesenti A: Alterations of lung and chest wall mechanics in patients with acute lung injury: effects of positive end-expiratory pressure. Am J Resp Crit Care Med 1995, 152: 531-537.CrossRefPubMed
21.
Beydon L, Svantesson C, Brauer K, Lemaire F, Jonson B: Respiratory mechanics in patients ventilated for critical lung disease. Eur Respir J 1996, 9: 262-273. 10.1183/09031936.96.09020262CrossRefPubMed
22.
Pelosi P, Croci M, Ravagnan I, Cerisara M, Vicardi P, Lissoni A, Gattinoni L: Respiratory system mechanics in sedated, paralyzed, morbidly obese patients. J Appl Physiol 1997, 82: 811-818.PubMed
23.
Antonaglia V, Peratoner A, De Simoni L, Gullo A, Milic-Emili J, Zin WA: Bedside assessment of respiratory viscoelastic properties in ventilated patients. Eur Respir J 2000, 16: 302-308. 10.1034/j.1399-3003.2000.16b19.xCrossRefPubMed
24.
Bates JHT: A recruitment model of quasi-linear power-law stress adaptation in lung tissue. Ann Biomed Eng 2007, 35: 1165-1174. 10.1007/s10439-007-9291-0CrossRefPubMed
25.
Ganzert S, Guttmann J, Kersting K, Kuhlen R, Putensen C, Sydow M, Kramer S: Analysis of respiratory pressure-volume curves in intensive care medicine using inductive machine learning. Artif Intell Med 2002, 26: 69-86. 10.1016/S0933-3657(02)00053-2CrossRefPubMed
26.
Stahl CA, Moller K, Schumann S, Kuhlen R, Sydow M, Putensen C, Guttmann J: Dynamic versus static respiratory mechanics in acute lung injury and acute respiratory distress syndrome. Crit Care Med 2006, 34: 2090-2098. 10.1097/01.CCM.0000227220.67613.0DCrossRefPubMed
27.
Zhao Z, Moller K, Steinmann D, Frerichs I, Guttmann J: Evaluation of an electrical impedance tomography-based global inhomogeneity index for pulmonary ventilation distribution. Intensive Care Med 2009, 35: 1900-1906. 10.1007/s00134-009-1589-yCrossRefPubMed
28.
Holzapfel L, Robert D, Perrin F, Blanc PL, Palmier B, Guerin C: Static pressure-volume curves and effect of positive end-expiratory pressure on gas exchange in adult respiratory distress syndrome. Crit Care Med 1983, 11: 591-597. 10.1097/00003246-198308000-00002CrossRefPubMed
29.
Putensen C, Baum M, Koller W, Putz G: The PEEP wave: an automated technic for bedside determination of the volume/pressure ratio in the lungs of ventilated patients. Der Anaesthesist 1989, 38: 214-219.PubMed
30.
Guttmann J, Eberhard L, Fabry B, Zappe D, Bernhard H, Lichtwarck-Aschoff , Adolph M, Wolff G: Determination of volume-dependent respiratory system mechanics in mechanically ventilated patients using the new SLICE method. Technol Health Care 1994, 2: 175-191.PubMed
31.
Sydow M, Burchardi H, Zinserling J, Ische H, Crozier TA, Weyland W: Improved determination of static compliance by automated single volume steps in ventilated patients. Intensive Care Med 1991, 17: 108-114. 10.1007/BF01691433CrossRefPubMed
32.
Matamis D, Lemaire F, Harf A, Brun-Buisson C, Ansquer JC, Atlan G: Total respiratory pressure-volume curves in the adult respiratory distress syndrome. Chest 1984, 86: 58-66. 10.1378/chest.86.1.58CrossRefPubMed
33.
Ingenito EP, Mark L, Davison B: Effects of acute lung injury on dynamic tissue properties. J Appl Physiol 1994, 77: 2689-2697.PubMed
34.
Bates JHT, Maksym GN, Navajas D, Suki B: Lung tissue rheology and 1/f noise. Ann Biomed Eng 1994, 22: 674-681. 10.1007/BF02368292CrossRefPubMed
35.
Chan KP, Stewart TE, Mehta S: High-frequency oscillatory ventilation for adult patients with ARDS. Chest 2007, 131: 1907-1916. 10.1378/chest.06-1549CrossRefPubMed
36.
Schumann S, Lichtwarck-Aschoff M, Haberthur C, Stahl CA, Moller K, Guttmann J: Detection of partial endotracheal tube obstruction by forced pressure oscillations. Respir Physiol Neurobiol 2007, 155: 227-233. 10.1016/j.resp.2006.05.010CrossRefPubMed
37.
Milic-Emili J, Robatto FM, Bates JHT: Respiratory mechanics in anaesthesia. Br J Anaesth 1990, 65: 4-12. 10.1093/bja/65.1.4-aCrossRefPubMed
38.
Kochi T, Okubo S, Zin WA, Milic-Emili J: Flow and volume dependence of pulmonary mechanics in anesthetized cats. J Appl Physiol 1988, 64: 441-450.PubMed
39.
Similowski T, Levy P, Corbeil C, Albala M, Pariente R, Derenne JP, Bates JHT, Jonson B, Milic-Emili J: Viscoelastic behavior of lung and chest wall in dogs determined by flow interruption. J Appl Physiol 1989, 67: 2219-2229.PubMed
40.
Bates JHT, Hunter IW, Sly PD, Okubo S, Filiatrault S, Milic-Emili J: Effect of valve closure time on the determination of respiratory resistance by flow interruption. Med Biol Eng Comput 1987, 25: 136-140. 10.1007/BF02442841CrossRefPubMed
41.
Kessler V, Mols G, Bernhard H, Haberthur C, Guttmann J: Interrupter airway and tissue resistance: errors caused by valve properties and respiratory system compliance. J Appl Physiol 1999, 87: 1546-1554.PubMed
42.
Edibam C, Rutten AJ, Collins DV, Bersten AD: Effect of inspiratory flow pattern and inspiratory to expiratory ratio on nonlinear elastic behavior in patients with acute lung injury. Am J Resp Crit Care Med 2003, 167: 702-707. 10.1164/rccm.2012110CrossRefPubMed
43.
Bates JHT, Brown KA, Kochi T: Identifying a model of respiratory mechanics using the interrupter technique. Proceedings of the Ninth American Conference IEEE Engineering Medical Biology Society 1987 1987, 1802-1803.
44.
Lagarias J, Reeds JA, Wright MH, Wright PE: Convergence Properties of the Nelder-Mead Simplex Method in Low Dimensions. SIAM Journal on Optimization 1998, 9: 112-147. 10.1137/S1052623496303470CrossRef
Metadata
Title
Pressure-dependent stress relaxation in acute respiratory distress syndrome and healthy lungs: an investigation based on a viscoelastic model
Authors
Steven Ganzert
Knut Möller
Daniel Steinmann
Stefan Schumann
Josef Guttmann
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2009
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc8203

Other articles of this Issue 6/2009

Critical Care 6/2009 Go to the issue

Research

Changes in stroke volume induced by passive leg raising in spontaneously breathing patients: comparison between echocardiography and Vigileo™/FloTrac™ device

Research

Management of severe crush injury in a front-line tent ICU after 2008 Wenchuan earthquake in China: an experience with 32 cases

Commentary

Recently published papers: Renal support in acute kidney injury - is low dose the new high dose?

Commentary

Is the way to man's heart (and lung) through the abdomen?

Research

Complications of continuous renal replacement therapy in critically ill children: a prospective observational evaluation study

Commentary

Searching for an ideal hemodynamic marker to predict short-term outcome in cardiogenic shock