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Finally, there is some evidence that insulin may increase alveolar sodium transport [ 29], and this may be achieved by an increased open probability of apical sodium channels [ 30].
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On the other hand, the increase of the inspired O2 fraction may also increase alveolar oxygen tension even when atelectasis exists [40].
An exercise-induced increase in ventilation may aggravate dynamic hyperinflation and thereby increase alveolar pressure at expiration.
In a similar context, the application of PEEP levels that inadvertently increase alveolar dead space may alter cerebral hemodynamics.
Indeed, previous studies suggest even the high dose we defined (average of 3.7 mg/day) may be inadequate to attempt to increase alveolar fluid clearance.
The inspiratory:expiratory ratio is generally set at a ratio of 1 2 as a default, but may be increased to 1 1 as needed in order to increase the mean alveolar pressure, to allow more time for filling of lung units with long time constants, and to increase alveolar recruitment.
The use of RMs may increase or hasten alveolar recruitment.
However, we could not exclude the possibility that it may increase the cyclic alveolar collapse of dependent lung regions, thus raising the risk of atelectasis and hypercapnia.
A recent study [ 10] challenged this approach, demonstrating that empirical PEEP setting frequently fails to induce alveolar recruitment and may increase the risk for alveolar over-inflation.
Furthermore, aberrant HOPX expression may contribute to increased alveolar senescence in IPF.
Further, using PaO2 to guide titration of MV settings (PEEP and Pplat) may result in increased alveolar instability and increase the potential for VILI.
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