Recruiting collapsed lung through collateral channels with positive end-expiratory pressure.

We studied reinflation of collapsed parts in excised normal human lungs through both the ordinary bronchial route and through collateral channels. A model of atelectasis was made either by simple collapse or by applying a positive pressure to the pleura and a negative to the airway. Five different ventilatory patterns were used for reinflation: simulated normal breathing with and without continuous positive airway pressure (CPAP), simulated deep breathing and mechanical ventilation with and without positive end-expiratory pressure (PEEP). All methods, except normal breathing without CPAP, reinflated the collapsed part with pressures well within the range used clinically. The most effective way of re-expanding collapsed lung was the application of CPAP during simulated normal breathing or PEEP during mechanical ventilation, which required smaller transpulmonary pressure swings than the other methods. A comparison between CPAP and PEEP showed CPAP to be preferable. Collateral reinflation occurred just as readily as normal reinflation and the results suggest that collateral reinflation is the primary choice. This route of reexpansion also has a potential secretion clearing effect in that pressure is built up distal to an obstruction.