"Concepts of Recruitment and their Application in the Newborn" by P. Dargaville for OPENPediatrics

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Thanks to the organizing committee for inviting me to speak. This is to me the ultimate walk on the wild side, getting a neonatal pediatric and adult intensivist in the same room, trying to cover the same subject. So it'll be interesting to see how it all pans out. I don't have a slide that says it, but I don't have any conflicts of interest to declare.

So getting right into this very interesting topic, I'm going to try to impart some general concepts of recruitment. And then in the last part of my talk, just give you a flavor of how we think about recruitment in the newborn lung, thinking about that interesting process of aerating the gasless lung at the beginning of life, about the diffuse alveolar diseases we deal with, and about the fact of the newborn lung being especially vulnerable.

So some of the concepts of recruitment bear thinking about carefully and hopefully will apply across the talks that you're going to hear. So if we think of recruitment as the process of applying transpulmonary pressure to open the air spaces, although you have to acknowledge it's what you do afterwards that also is equally important, I'm going to try to tell you a little bit about the concepts of alveolar opening and closing pressures, about superimposed pressure, about the time dependence of opening and closing, which we'll see in the segue from this concept section to that of the newborn lung, and talk a little bit about the potential benefits of recruitment.

People have be interested in the volume response to pressure in the lung for many years. Here's an example of a panel from a paper by Salazar and Knowles, published in 1964 from Harvard. And they got volunteers to inhale, measured their lung volume and the negative pressure they were generating. And for each subject, I would draw our graph like this which shows the trajectory of lung volume as pressure is applied in this case by negative pressure.

So transpulmonary pressure applied, and an exponential relationship, as one would imagine, leading ultimately to an asymptote at the maximum volume. And they were able to show that the volume at any given point could be related to the maximum volume, to the applied pressure at that particular point, and to this constant, called the half inflation pressure, which was in essence the pressure at which the lung had reached half its ultimate volume.

And people started to think maybe this sort of consideration could be applied within the micro architecture of the lung. So let's now think about a lung composed of many millions of alveoli-- many, many units, which might have a behavior that could be similar to that described for the whole lung by Salazar and Knowles.

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