Document Detail

Effect of PEEP on work of breathing in mechanically ventilated COPD patients.
MedLine Citation:
PMID:  11089744     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To study the effects of PEEP on the inspiratory work done per breath on the respiratory system (W(I,rs)) in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Physiological study. SETTING: Fourteen-bed Medical ICU of a 1,000-bed teaching tertiary hospital. PATIENTS AND PARTICIPANTS: Ten patients with COPD intubated and mechanically ventilated for acute respiratory failure. INTERVENTIONS: PEEP of 0 (ZEEP), 5, 10, and 15 cm H2O were applied randomly and measurements done at the end of a 15-20 min period. MEASUREMENTS AND RESULTS: Using the rapid airway occlusion technique during constant flow inflation, we partitioned W(I,rs) into its static and dynamic components. On ZEEP, the mean +/- SD values of W(I,rs) amounted to 15.1 +/- 5.7 cm H2O x 1. With increasing PEEP, W(I,rs) was significantly reduced to 12.6 +/- 5.7, 11.1 +/- 4.1, and 10.4 +/- 2.8 cm H2O x 1 at PEEP of 5, 10, and 15 cm H2O, respectively (P < 0.05). This reduction was entirely due to the decline of the work due to intrinsic PEEP (PEEPi) and was abolished when the applied PEEP counterbalanced PEEPi. The other components of W(I,rs) were not affected by PEEP. By increasing PEEP up to the level of PEEPi on ZEEP, no further increase in end-expiratory lung volume was observed. CONCLUSIONS: In COPD patients the application of PEEP levels close to PEEPi can substantially reduce W(I,rs) without promoting further dynamic pulmonary hyperinflation.
C Guerin; J Milic-Emili; G Fournier
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Intensive care medicine     Volume:  26     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2000 Sep 
Date Detail:
Created Date:  2001-03-09     Completed Date:  2001-05-31     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1207-14     Citation Subset:  IM    
Service de Réanimation Médicale et Assistance Respiratoire, Hôpital de la Croix-Rousse, Lyon, France.
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MeSH Terms
Analysis of Variance
Lung Diseases, Obstructive / complications,  physiopathology,  therapy*
Middle Aged
Positive-Pressure Respiration*
Respiratory Insufficiency / etiology,  physiopathology,  therapy
Ventilator Weaning*
Work of Breathing*
Comment In:
Intensive Care Med. 2000 Sep;26(9):1167-9   [PMID:  11089736 ]

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

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