Evaluation of the Potential for Lung Recruitment with the Recruitment-to-Inflation Ratio during General Anesthesia
Bibliographic record
Abstract
BACKGROUND: During general anesthesia, the effect of positive end-expiratory pressure (PEEP) on lung injury depends on the potential for lung recruitment, which is variable among patients. The recruitment-to-inflation ratio (R/I) is measured from ventilator data during a single-breath PEEP-release maneuver and has been proposed to assess recruitability without the need for additional equipment during acute respiratory distress syndrome. This study hypothesized that R/I reliably estimates the individual potential for lung recruitment during general anesthesia. METHODS: Twenty patients undergoing open abdominal surgery received mechanical ventilation with PEEP of 12 cm H 2 O for 30 min, which was then abruptly reduced to 2 cm H 2 O. Finally, a decremental PEEP trial was performed to measure collapse and overdistension at each level. Gas exchange, end-tidal carbon dioxide, respiratory mechanics by ventilator waveform analysis, regional overdistension and collapse by electrical impedance tomography, end-expiratory lung volume, and functional residual capacity by nitrogen dilution were measured. The R/I was calculated during the single-breath derecruitment maneuver from ventilator data. RESULTS: The R/I (median = 0.41, range = 0 to 0.86) was linearly correlated with recruited volume normalized to functional residual capacity measured by gas dilution (r = 0.48, slope = 0.27 [0.03, 0.52]), and recruited volume scaled to PEEP-induced inflation volume measured by tomography (r = 0.82, slope = 1.2 [0.77, 1.64]). Compared to patients with R/I of less than or equal to 0.40 (n = 10), those with R/I greater than 0.40 (n = 10) required higher PEEP to optimize regional mechanics and balance collapse and overdistension (median [quartile 1, quartile 3]: 10 [8, 11] cm H 2 O vs . 8 [7, 9]; P = 0.03) and showed decreases in dead space (-2 [-5, 1] % vs . 3 [0, 5]%; P = 0.013) and greater reductions in collapse (-44 [-31, -47] % vs . -30 [-20, -38]%; P = 0.016) and dynamic lung strain (-0.06 [-0.09, -0.05] vs . -0.04 [-0.05, -0.02]; P = 0.04) with higher PEEP. CONCLUSIONS: During general anesthesia, the R/I reflects potential for lung recruitment. The R/I may help identify patients in whom higher PEEP improves physiology and may favor less injurious ventilation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".