context: BACKGROUND: Routine use of positive end-expiratory pressure (based on the pressure at the lower inflection point on the static total respiratory compliance curve) along with a maneuver to recruit atelectatic lung has been advocated after cardiothoracic surgery. OBJECTIVES: To determine if the lower inflection point is related to outcomes in @entity0 after sternotomy and cardiopulmonary bypass. METHOD: A prospective observational study involving estimation of the lower inflection point on the inflation pressure-volume plot obtained with a low-flow technique. Duration of intubation, length of stay, @entity1 , and results of spirometry were compared between @entity0 with a "high " inflection point (> or =10 cm @entity2 ) and @entity0 with a "low" inflection point (< or =5 cm @entity2 ). RESULTS: Ninety-five @entity0 were enrolled. After exclusion for incomplete data, 65 @entity0 (49 @entity0 , 16 @entity0 ; mean age, 66.1 years; SD, 9.5 years) were included. The mean lower inflection point was 6.33 cm @entity2 (SD, 3.4 cm @entity2 ). A second lower inflection point was observed on 5 plots (mean, 21 cm @entity2 ; SD, 1.4 cm @entity2 ). Nine @entity0 had high inflection points (mean, 13.1 cm @entity2 ; SD, 3.0 cm @entity2 ), and 33 had low inflection points (mean, 3.9 cm @entity2 ; SD, 0.98 cm @entity2 ). No outcome measures differed between groups. CONCLUSIONS: In @entity0 with short intubation times and predictable postoperative course, general use of a lung recruitment strategy involving sustained inflations and adjustment of positive end-expiratory pressure based on the lower inflection point is difficult to justify.
  