Intensive Care Medicine

, Volume 45, Issue 2, pp 290–291 | Cite as

Mechanism of airway closure in acute respiratory distress syndrome: a possible role of surfactant depletion

  • Remi Coudroy
  • Cong Lu
  • Lu Chen
  • Alexandre Demoule
  • Laurent BrochardEmail author

Dear Editor,

We recently reported the presence of airway closure in patients with acute respiratory distress syndrome (ARDS), evidenced by a low-flow inflation pressure–volume (PV) curve [1]. We noticed that the initial slope of the respiratory system PV curve was extremely low in some patients and corresponded to the compliance of the circuit, therefore suggesting complete airway closure. Respiratory system compliance (Crs) suddenly increased above a threshold, named airway opening pressure (AOP) [1]. We concluded that 1) AOP have been missed in the past, and 2) mechanisms leading to airway closure are unknown. Some data suggest that the air–liquid interface creates high surface tension in the small airways and could cause their closure. Surfactant depletion, as often observed in ARDS, could play a role.

Using previously published data, we conducted a post hoc analysis of a study investigating the relationship between PV curves and bronchoalveolar lavage (BAL) in ARDS [2]. Our...


Compliance with ethical standards

Conflicts of interest

RC reports travel expenses to attend scientific meetings by MSD and Fisher & Paykel. None for CL and LC. LB’s laboratory has received grants or equipment from Covidien-Medtronic, Fisher Paykel, Air Liquide, Philips, General Electric.

Supplementary material

134_2018_5501_MOESM1_ESM.docx (39 kb)
Supplementary material 1 (DOCX 38 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Remi Coudroy
    • 1
    • 2
    • 3
    • 4
  • Cong Lu
    • 5
  • Lu Chen
    • 3
    • 4
  • Alexandre Demoule
    • 6
    • 7
  • Laurent Brochard
    • 3
    • 4
    Email author
  1. 1.Service de Réanimation MédicaleCHU de PoitiersPoitiersFrance
  2. 2.INSERM CIC1402, groupe ALIVEUniversité de PoitiersPoitiersFrance
  3. 3.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  4. 4.Keenan Research Centre and Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  5. 5.Department of Pediatric Critical Care MedicineBeijing Children’s Hospital, Capital Medical University, National Center for Children’s HealthBeijingChina
  6. 6.Service de Pneumologie et Réanimation Médicale du Département R3SAP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles FoixParisFrance
  7. 7.INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance

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