Purpose of review
The aim of this article is to describe the physiologic utility,
correlation with lung morphology, difficulties in interpretation and
current clinical applications of static-volume curves at the bedside in
patients with acute lung respiratory system pressure injury or acute
respiratory distress syndrome.
Recent findings
Complex interpretation of pressure-volume curves indicates that alveolar
reopening continues past the lower inflection point on the linear part
of the curve and suggests the presence of homogeneous lung disease in
which recruitment is still possible by positive end-expiratory pressure
application. Setting positive end-expiratory pressure above the lower
inflection point and tidal ventilation (approximately 6 ml/kg) in the
linear portion of the respiratory system pressure-volume curve improved
mortality and ameliorated lung and plasma inflammatory mediators
compared with ventilation with the lowest positive end-expiratory
pressure at traditional tidal volumes. Recent studies have found that
regular use of pressure-volume curves provides useful physiological data
that help to optimize mechanical ventilation at the bedside.
Summary
The physiologic data obtained by measuring the static pressure-volume
curves have helped clinicians to better understand the behavior of the
respiratory system when positive-pressure ventilation is applied. The
advanced technology incorporated into modern ventilators allows routine
measurement of pressure-volume curves under sedation without paralysis,
with acceptable variability and no serious adverse effects.
