Document Detail

Effects of PEEP on oxygenation and respiratory mechanics during one-lung ventilation.
MedLine Citation:
PMID:  15980044     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: One-lung ventilation-related hypoxaemia (OLV-RH) can occur in patients with healthy lungs. In this case, PEEP frequently improves oxygenation. The aim of this study was to determine, in a healthy lung model of OLV, whether the increase in PEEP improved oxygenation and whether the mechanisms involved include both inspiratory lung recruitment and an end-expiratory lung volume increase. Since inhaled nitric oxide (iNO) may have a synergistic effect on oxygenation in the case of PEEP-induced recruitment, their association was also tested. METHODS: Twenty pigs were studied during open-chest, left OLV. Arterial blood gases and haemodynamic variables were measured at different levels of PEEP (0, 5, 10 and 15 cm H(2)O) applied in random order with or without iNO 4 p.p.m. Pressure-volume curves were measured at each level of PEEP. RESULTS: PEEP(5) and PEEP(10) improved Pa(O(2))/FI(O(2)) ratio (P<0.005) and shunt (P<0.005) regardless of the presence of iNO. PEEP(15) improved oxygenation and shunt only when it was associated with iNO (P<0.001). Whereas PEEP(5), PEEP(10) and PEEP(15) were associated with a significant increase in end-expiratory volume (P<0.001), only PEEP(5) and PEEP(10) were associated with continuous lung volume recruitment (P<0.01). Moreover, PEEP(15) induced a significant decrease in linear compliance (P<0.001). CONCLUSIONS: In a healthy porcine lung model of OLV-RH, moderate PEEP can improve oxygenation. This effect implies both expiratory and inspiratory pulmonary recruitment. Co-administration of 4 p.p.m. iNO was ineffective.
P Michelet; A Roch; D Brousse; X-B D'Journo; F Bregeon; D Lambert; G Perrin; L Papazian; P Thomas; J-P Carpentier; J-P Auffray
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Publication Detail:
Type:  Journal Article     Date:  2005-06-24
Journal Detail:
Title:  British journal of anaesthesia     Volume:  95     ISSN:  0007-0912     ISO Abbreviation:  Br J Anaesth     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-07-11     Completed Date:  2005-08-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  267-73     Citation Subset:  IM    
Département d'Anesthésie Réanimation, Hôpitaux Sud, Marseille, France.
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MeSH Terms
Lung / metabolism*
Lung Volume Measurements
Models, Animal
Nitric Oxide / metabolism
Oxygen / metabolism*
Positive-Pressure Respiration*
Respiration, Artificial*
Respiratory Mechanics*
Reg. No./Substance:
10102-43-9/Nitric Oxide; 7782-44-7/Oxygen

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