Volume 19 Supplement 1
Absence of lung sliding is not a reliable indicator of pneumothorax in patients who require high PEEP
© Golub et al.; licensee BioMed Central Ltd. 2015
Published: 16 March 2015
The objective of our study was to estimate correlation between PEEP and disappearance of lung sliding (LS) due to lung overdistension in the absence of pneumothorax.
We performed a prospective study from September 2013 to May 2014 in adult patients with respiratory failure who required mechanical ventilation, lung CT and recruitment manoeuvre. Lung CT was used as the gold standard to exclude pneumothorax. A staircase recruitment manoeuvre was used with 5 cmH2O increases of PEEP from baseline to 35 cmH2O and decreases in reverse order. The duration of each step was 1 minute. Lung ultrasound was performed to evaluate LS at each step in one intercostal window in the highest point of left and right hemithoraces by physicians trained in lung ultrasound and blinded to changes in PEEP.
According to this study, higher PEEP levels correlate with disappearance of LS without pneumothorax. Absence of LS in patients with high PEEP should be interpreted with caution and other signs of pneumothorax should be sought before therapeutic interventions are attempted.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.