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We tested the hypothesis that adjusting tidal volume (VT) to a non-injurious SI in an open lung condition avoids hypoventilation while preventing overdistension in an experimental model of combined lung injury and low chest-wall compliance (Ccw).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Lung injury was induced by repeated lung lavages using warm saline solution, and Ccw was reduced by controlled intra-abdominal air-insufflation in 22 anesthetized, paralyzed and mechanically ventilated pigs. After injury animals were recruited and submitted to a positive end-expiratory pressure (PEEP) titration trial to find the PEEP level resulting in maximum compliance. During a subsequent four hours of mechanical ventilation, VT was adjusted to keep a plateau pressure (Pplat) of 30 cmH2O (Pplat-group, n\u2009=\u200911) or to a SI between 0.95 and 1.05 (SI-group, n\u2009=\u200911). Respiratory rate was adjusted to maintain a \u2018normal\u2019 PaCO2 (35 to 65\u00a0mmHg). SI, lung mechanics, arterial-blood gases haemodynamics pro-inflammatory cytokines and histopathology were analyzed. In addition Computed Tomography (CT) data were acquired at end expiration and end inspiration in six animals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>PaCO2 was significantly higher in the Pplat-group (82 versus 53\u00a0mmHg,<jats:italic>P<\/jats:italic>\u2009=\u20090.01), with a resulting lower pH (7.19 versus 7.34,<jats:italic>P<\/jats:italic>\u2009=\u20090.01). We observed significant differences in VT (7.3 versus 5.4 mlKg<jats:sup>\u22121<\/jats:sup>,<jats:italic>P<\/jats:italic>\u2009=\u20090.002) and Pplat values (30 versus 35 cmH2O,<jats:italic>P<\/jats:italic>\u2009=\u20090.001) between the Pplat-group and SI-group respectively. SI (1.03 versus 0.99,<jats:italic>P<\/jats:italic>\u2009=\u20090.42) and end-inspiratory transpulmonary pressure (P<jats:sub>TP<\/jats:sub>) (17 versus 18 cmH2O,<jats:italic>P<\/jats:italic>\u2009=\u20090.42) were similar in the Pplat- and SI-groups respectively, without differences in overinflated lung areas at end- inspiration in both groups. Cytokines and histopathology showed no differences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Setting tidal volume to a non-injurious stress index in an open lung condition improves alveolar ventilation and prevents overdistension without increasing lung injury. This is in comparison with limited Pplat protective ventilation in a model of lung injury with low chest-wall compliance.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s13054-014-0726-3","type":"journal-article","created":{"date-parts":[[2015,1,9]],"date-time":"2015-01-09T18:23:46Z","timestamp":1420827826000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Adjusting tidal volume to stress index in an open lung condition optimizes ventilation and prevents overdistension in an experimental model of lung injury and reduced chest wall compliance"],"prefix":"10.1186","volume":"19","author":[{"given":"Carlos","family":"Ferrando","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Su\u00e1rez-Sipmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Gutierrez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerardo","family":"Tusman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose","family":"Carbonell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marisa","family":"Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Piqueras","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Desamparados","family":"Compa\u00f1","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanie","family":"Flores","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Soro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicia","family":"Llombart","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco Javier","family":"Belda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2015,12,1]]},"reference":[{"key":"726_CR1","doi-asserted-by":"crossref","unstructured":"Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. 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