Figure 2

Effects of recruitment in alveolar stability. Alveolar stability can be achieved by the equilibrium between end-inspiratory and end-expiratory volumes. This stability allows definition of a hypothetical safe zone (blue area). Because strain can be viewed as the ratio between these volumes, this zone corresponds to normal or lower strain values. On the contrary, excessive end-inspiratory deformation in lungs with a low resting volume leads to alveolar instability (red area). The arrows represent how the tidal volume (Vt) and positive end-expiratory pressure (PEEP) modify the end-inspiratory/end-expiratory ratio. In recruitable lungs, PEEP induces an increase in end-expiratory lung volume that allows ventilation to stay in the safe zone, and strain decreases. In the absence of recruitment, however, both the Vt and PEEP lead to a predominant increase in end-inspiratory volume, therefore increasing strain. FRC, functional residual capacity.