Document Detail

Comparison of static and dynamic measurements of intrinsic PEEP in mechanically ventilated patients.
MedLine Citation:
PMID:  7952559     Owner:  NLM     Status:  MEDLINE    
Intrinsic positive end-expiratory pressure (PEEPi) is routinely determined under static conditions by occluding the airway at end-expiration (PEEPi,stat), the resulting plateau pressure representing the average PEEPi present within a nonhomogeneous lung. In contrast, PEEPi can also be evaluated dynamically (PEEPi,dyn) by recording the change in pressure required to initiate lung inflation. It has been suggested that PEEPi,dyn reflects the lowest regional PEEPi, and therefore underestimates PEEPi,stat in the presence of heterogenous mechanical properties. The purposes of this study were (1) to compare PEEPi obtained with these two methods in mechanically ventilated patients with significant airway obstruction (AWO) and those without (non-AWO), and (2) to relate any discrepancies observed with other indices of respiratory mechanics. PEEPi,stat, PEEPi,dyn, and respiratory mechanics were measured during controlled mechanical ventilation in 22 sedated, paralyzed patients. PEEPi,dyn was significantly less than PEEPi,stat in AWO, averaging 3.0 +/- 0.5 (SEM) and 9.3 +/- 1.1 (SEM) cm H2O, respectively (p < 0.0001). In contrast, these values were more comparable in non-AWO, averaging 4.6 +/- 0.8 and 5.4 +/- 1.0 cm H2O (p > 0.05). As a result, the ratio of PEEPi,dyn to PEEPi,stat amounted to 0.36 +/- 0.06 for AWO compared with 0.87 +/- 0.05 in non-AWO (p < 0.005). Maximal (Rmax) and minimal (Rmin) respiratory resistance were greater in AWO whereas respiratory compliance (Crs) was no different between groups. PEEPi,dyn/PEEPi,stat was inversely related to delta P, the pressure losses attributable to time constant inequalities and viscoelastic tissue properties (r = 0.64, p < 0.005). No correlation was found between this ratio and Rmax, Rmin, or Crs.(ABSTRACT TRUNCATED AT 250 WORDS)
F Maltais; H Reissmann; P Navalesi; P Hernandez; A Gursahaney; V M Ranieri; M Sovilj; S B Gottfried
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  150     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  1994 Nov 
Date Detail:
Created Date:  1994-12-13     Completed Date:  1994-12-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1318-24     Citation Subset:  AIM; IM    
Division of Respiratory Medicine, Montreal General Hospital, Quebec, Canada.
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MeSH Terms
Airway Resistance
Asthma / physiopathology,  therapy
Lung Diseases, Obstructive / physiopathology,  therapy
Middle Aged
Positive-Pressure Respiration, Intrinsic / diagnosis*,  physiopathology
Pulmonary Ventilation
Respiration, Artificial*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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