Document Detail


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
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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.
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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


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