Some information about PEEP and lung recruitment. The videos are astounding.
Alveolar recruitment and maintenance of lung volume are important goals in the treatment of acute lung injury (ALI) and essential for improving oxygenation. The most usual employed strategy to achieve this goal is the use of positive end-expiratory pressure (PEEP). Recruitment and collapse are highly dynamic phenomena that are difficult to monitor. Dynamic effects of regional ventilation can be monitored by electrical impedance tomography (EIT) at the bedside. We investigated the ability of EIT for providing a useful tool to detect dynamic changes of regional breath by breath recruitment at the bedside during an incremental and decremental PEEP trial in experimental lung injury. In addition, we analyzed pressure–volume (P–V) curves computed by EIT data. [...] Stepwise PEEP recruitment maneuvers can open collapsed lungs and certain PEEP levels are necessary to keep the lungs open. Monitoring of ΔV EIT is capable of detecting the dynamic process of recruitment and derecruitment at bedside. Plotting regional P–V curves from EIT data provides continuous information that may be of use in determining the PEEP level to maintain recruitment in acute lung injury.