PEEP Recruitment-comparison Between Ultrasonographic Assessment and LIP Assessment

Positive End-expiratory Pressure Induced Lung Recruitment -Comparison Between Ultrasonographic Assessment and Lower Inflection Point Assessment on the Pressure -Volume Loop

The purpose of this study is to compare lung recruitment in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) based on lower inflection point with transthoracic ultrasonographic assessment of lung recruitment.

Sedated and sometimes temporary relaxed patients with ALI/ARDS on mechanical ventilation in semirecumbent position are included. Lower inflection point on pressure volume loop on ventilator Draeger Evita 4 with low continuous flow on volume controlled ventilation is measured with zero PEEP. Transthoracic lung ultrasound with linear probe is proceed on both hemithoraces when mechanical ventilation based on measured PEEP is started. We compare if real lung recruitment seen by ultrasound is the same as predicted by lower inflection point.

The procedure is a part of routine everyday respiratory monitoring in our unit.

Inclusion Criteria:

• patients with diffuse ALI/ARDS on mechanical ventilation with visible lower inflection point on dynamic P-V loops

Exclusion Criteria:

• preexisting parenchymal or pleural lung disease