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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2001 April;67(4):228-37

language: English

Pressure-volume curve: methods and meaning

Maggiore S. M., Brochard L.

From the Depart­ment of Med­i­cal Inten­sive ­Care Uni­ver­sity of Par­is XII, Hen­ri Mon­dor Hos­pi­tal Créteil, ­France


The pres­sure-vol­ume ­curve of the res­pir­a­to­ry ­system is a phys­io­log­i­cal meth­od ­used for diag­nos­tic pur­pos­es to ­describe the stat­ic mechan­i­cal prop­er­ties of the res­pir­a­to­ry ­system. A renew­al of inter­est in the pres­sure-vol­ume ­curve has recent­ly ­appeared ­because of experi­men­tal evi­dence regard­ing the infor­ma­tion con­veyed by the ­curve, a bet­ter under­stand­ing of the path­o­phy­sio­log­ic fac­tors influ­enc­ing its inter­pre­ta­tion and the ben­e­fi­cial ­results of clin­i­cal ­trials ­based on the use of the pres­sure-vol­ume ­curve for ven­til­a­to­ry man­age­ment of ­acute res­pir­a­to­ry dis­tress syn­drome. ­Thus, adapt­ing ven­til­a­to­ry set­tings to indi­vid­u­al char­ac­ter­is­tics of the ­patients in ­terms of res­pir­a­to­ry mechan­ics may be an extreme­ly impor­tant ­aspect for a bet­ter man­age­ment of the ­most dif­fi­cult to ven­ti­late ­patients ­with ­acute ­lung inju­ry. ­There is con­sid­er­able experi­men­tal evi­dence ­that ­both the open­ing-col­lapse phe­nom­e­na and the exces­sive ­lung ­stretch may ­cause dam­age to the ­lungs. There­fore ­tools allow­ing an indi­vid­u­al titra­tion of ven­til­a­to­ry set­tings tak­ing ­into ­account the con­straints of the res­pir­a­to­ry ­system ­seem high­ly desir­able. The pres­sure-vol­ume ­curve ­might be eas­i­ly achiev­able at the bed­side as a mon­i­tor­ing ­tool. The low-­flow tech­nique ­using ven­ti­la­tor tech­nol­o­gy has sev­er­al poten­tial advan­tag­es. It is hope­ful to ­think ­that in the ­future the meas­ure­ment of the P-V ­curve and the quan­tifi­ca­tion of alveo­lar recruit­ment may be eas­i­ly pro­vid­ed at the bed­side and may ­help for the titra­tion of the ven­til­a­to­ry set­tings in clin­i­cal prac­tice. ­This ­review ­will ­focus brief­ly on the phys­io­log­ic back­ground, tech­nique descrip­tion, and ­recent advanc­es con­cern­ing the inter­pre­ta­tion of the P-V ­curve in the crit­i­cal­ly ill ­patients.

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