Alveolar derecruitment at decremental positive end-expiratory pressure levels in acute lung injury: comparison with the lower inflection point, oxygenation, and compliance

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We examined the hypothesis that recording multiple elastic pressure-volume (Pel/V) curves and calculating alveolar derecruitment (V(DER)) induced by decreasing positive end-expiratory pressure (PEEP) may allow determination of alveolar closing pressures, thus helping to select the optimal PEEP level. V(DER) measured in 16 patients with acute lung injury (ALI) was compared with the lower inflection point (LIP) and oxygenation changes. A modified automated method was used to record multiple Pel/V curves at low constant flow. PEEP was decreased in 5-cm H(2)O steps, from 20 or 15 cm H(2)O to 0 cm H(2)O (ZEEP). V(DER) was the volume loss between the curves recorded from PEEP and from ZEEP at the same Pel. Derecruitment occurred at each PEEP decrement, being spread almost uniformly over the 20/15 to 0 cm H(2)O range. V(DER) was not correlated with LIP. V(DER) changes correlated with Pa(O(2))/FI(O(2)) changes (rho = 0.6, p = 0.02). Linear compliance at ZEEP was correlated to V(DER) at PEEP 15 cm H(2)O (rho = 0.9, p = 0.001), suggesting that compliance above LIP may reflect the amount of recruitable lung. Thus, alveolar closure in ALI occurs over a wide range of pressures, and LIP is a poor predictor of alveolar closure.


  • Salvatore M Maggiore
  • Björn Jonson
  • Jean-Christophe Richard
  • Samir Jaber
  • Francois Lemaire
  • Laurent Brochard
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Respiratory Medicine and Allergy


  • lower inflection point, elastic pressure-volume curves, PEEP, derecruitment, acute lung injury
Original languageEnglish
Pages (from-to)795-801
JournalAmerican Journal of Respiratory and Critical Care Medicine
Issue number5
Publication statusPublished - 2001
Publication categoryResearch