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Interpretation of PV Curves

Dr. Bryan makes an important point. He believes that auto-PEEP in infant lungs, and to a lesser extent in juvenile lungs, is responsible for the relative protection against ventilator-induced lung injury compared with adult lungs (1). However, he acknowledges that it has never been measured. The demonstration of the pattern of expansion and collapse of the subpleural alveoli, heterogeneous in the susceptible adult and homogeneous in the protected infant, implicitly supports such an hypothesis, but the connection was certainly not made explicit in our discussion. Although we know of no current means to prove or disprove this hypothesis beyond inference, our belief has evolved toward accepting that auto-PEEP may indeed be the key explanation for the phenomenon we described in our paper. Some time in the future this issue will be proved or disproved. We suspect that Dr. Bryan will be proven correct.

Alik Kornecki and Brian P. Kavanagh

The Hospital for Sick Children, Toronto, Ontario, Canada

FOOTNOTES

Conflict of Interest Statement: Neither of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Kornecki A, Tsuchida S, Ondiveeran HK, Engelberts D, Frndova H, Tanswel AK, Martin Post M, McKerlie C, Belik J, Fox-Robichaud A, et al. Lung development and susceptibility to ventilator-induced lung injury. Am J Respir Crit Care Med 2005;171:743–752.[Abstract/Free Full Text]

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