| Auto-PEEP in the multisystem injured patient: an elusive complication. | |
MedLine Citation:
|
PMID: 2231798 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Auto-PEEP (A-PEEP), unrecognized alveolar positive and expiratory pressure during mechanical ventilation, is an acknowledged hazard in patients with chronic obstructive lung disease. We evaluated 50 consecutive trauma patients for the presence of A-PEEP and its effect on hemodynamic stability. Injury Severity Scores (ISS) were 8 to 41 (21 +/- 1); Revised Trauma Scores (RTS) ranged from 2.0 to 7.8 (6.2 +/- 0.2). Mode of ventilation was assist control, inspiratory flow rates were 40 to 120 L/M (78 +/- 2). A-PEEP, determined in the non-assisting patient by occluding the expiratory port at end exhalation, was present in 28 patients (56%) and ranged from 1 to 12 cm H2O (5.3 +/- 0.4 cm H2O). Data segregated by A-PEEP versus no A-PEEP were as follows (Mean +/- SEM): [table: see text] *P less than 0.05, VE = minute ventilation, Paw = mean airway pressure. Upon reversal of A-PEEP in the eight patients with levels greater than 5 cm H2O, mean blood pressure rose from 90 +/- 17 to 102 +/- 22 mm Hg and central venous pressure fell from 13 +/- 5 to 7 +/- 5 mm Hg. A-PEEP was successfully treated in these eight patients by increasing peak flows, minimizing VE requirements and selective use of bronchodilators. In sum, the hypermetabolic ventilated trauma patient should be monitored routinely for this common phenomenon which may have profound cardiopulmonary effects in the setting of acute resuscitation. |
Authors:
|
F A Moore; J B Haenel; E E Moore; C M Abernathy |
Related Documents
:
|
19175578 - Beneficial effects of high positive end-expiratory pressure in lung respiratory mechani... 12579058 - Influence of low tidal volumes on gas exchange in acute respiratory distress syndrome a... 17194318 - Setting positive end-expiratory pressure during jet ventilation to replicate the mean a... 12687028 - Effects of positive end-expiratory pressure on oscillated volume during high frequency ... 2569178 - Relationship between cardiovascular neurones and descending antinociceptive pathways in... 2269788 - Carpal tunnel syndrome secondary to wrist and finger flexor spasticity. |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: The Journal of trauma Volume: 30 ISSN: 0022-5282 ISO Abbreviation: J Trauma Publication Date: 1990 Nov |
Date Detail:
|
Created Date: 1990-12-14 Completed Date: 1990-12-14 Revised Date: 2004-11-17 |
Medline Journal Info:
|
Nlm Unique ID: 0376373 Medline TA: J Trauma Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 1316-22; discussion 1322-3 Citation Subset: AIM; IM |
Affiliation:
|
Department of Surgery, Denver General Hospital, CO 80204-4507. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Adult Aged Aged, 80 and over Airway Resistance Central Venous Pressure Female Functional Residual Capacity Humans Incidence Male Middle Aged Multiple Trauma / therapy* Positive-Pressure Respiration* Prospective Studies Pulmonary Wedge Pressure Respiration Disorders / epidemiology, etiology*, physiopathology Respiration, Artificial / adverse effects*, methods Risk Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Fifty two-week chronic oral toxicity study of mofezolac (N-22) in rats
Next Document: Gunshot injuries to the hip and abdomen: the association of joint and intra-abdominal visceral injur...