Document Detail


Computer-controlled optimization of positive end-expiratory pressure.
MedLine Citation:
PMID:  3091319     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Positive end-expiratory pressure (PEEP) is a standard treatment for patients with refractory hypoxemia due to an acute restrictive pathology. The therapeutic range of PEEP can be quite narrow. PEEP therapy has been optimized using invasive variables such as oxygen transport and pulmonary shunt, and noninvasive variables such as compliance; however, the measurements are complex. We constructed a computerized PEEP-optimization system consisting of a Siemens 900C ventilator, Siemens prototype sulfur hexafluoride analyzer, Siemens 940 lung mechanics analyzer, and a DEC 11/23 microcomputer. The user may choose from three different noninvasive PEEP titration algorithms: maximizing static total respiratory system compliance (CTR), maximizing functional residual capacity(FRC)-based compliance (CFRC), and normalizing FRC. The device was tested in six dogs with pulmonary injury induced by oleic acid. The system was constrained to 3-cm H2O PEEP steps at 20-min intervals. The algorithm normalizing FRC reached optimal PEEP levels in 40 min, with a mean difference from the desired FRC of 15 +/- 48 (SEM) ml. This corresponds to a mean percent error of 1.0% +/- 2.63%. The CFRC and CTR algorithms reached optimal PEEP levels in 60 and 40 min, respectively, and maintained a maximal compliance for 85% of the time. This system provides fully automated noninvasive PEEP titration and is flexible enough to incorporate easily any other PEEP titration algorithms. It should improve patient care by guaranteeing that PEEP therapy is truly optimized throughout the patient's recovery.
Authors:
T D East; K P Andriano; N L Pace
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Critical care medicine     Volume:  14     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  1986 Sep 
Date Detail:
Created Date:  1986-10-03     Completed Date:  1986-10-03     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  792-7     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Animals
Carbon Dioxide / analysis
Cardiac Output
Computers
Dogs
Functional Residual Capacity
Lung Compliance
Lung Volume Measurements
Monitoring, Physiologic
Positive-Pressure Respiration / instrumentation,  methods*
Respiratory Distress Syndrome, Adult / therapy
Software
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide

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


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