Document Detail

Effects of extrinsic positive end-expiratory pressure on mechanically ventilated patients with chronic obstructive pulmonary disease and dynamic hyperinflation.
MedLine Citation:
PMID:  8366227     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To examine the circulatory and respiratory effects of extrinsic positive end-expiratory pressure (PEEPe) in patients with chronic obstructive pulmonary disease (COPD) and dynamic hyperinflation during controlled mechanical ventilation. DESIGN: Different levels of PEEPe were applied randomly in mechanically ventilated patients with COPD and dynamic hyperinflation. SETTING: Respiratory Intensive Care Unit of a University Hospital. PATIENTS: 9 patients with acute respiratory failure and dynamic hyperinflation due to acute exacerbation of COPD. INTERVENTIONS: PEEPe 35%, 58% and 86% of intrinsic PEEP (PEEPi) were applied. MEASUREMENTS AND RESULTS: Using flow-directed pulmonary artery catheters hemodynamic measurements were obtained, while simultaneously lung volumes, airflows and airway pressures were recorded. In order to estimate alveolar pressures (Palv), rapid airway occlusions during passive expiration were also performed. At no level of PEEPe were significant changes in cardiac output, gas exchange variables, dead space, airways inflation resistances and respiratory system static end-inspiratory compliance observed. At high level of PEEPe central venous, mean pulmonary arterial and pulmonary capillary wedge pressures were increased significantly. All but one patient were flow-limited during passive expiration. PEEPe 86% of PEEPi caused a significant increase in end-expiratory lung volume and total PEEP. Iso-volume pressure-flow curves showed volume-dependence expiratory flow limitation in 2 patients, while in 8 patients volume-dependence of critical driving pressure (Palv-mouth pressure) that decreased flows was also observed. CONCLUSIONS: The effects of PEEPe on iso-volume flow and hence on lung mechanics and hemodynamics, depend on many factors, such as airways resistances, lung volumes and airway characteristics, making the patient response to PEEPe unpredictable.
D Georgopoulos; E Giannouli; D Patakas
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Intensive care medicine     Volume:  19     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  1993  
Date Detail:
Created Date:  1993-10-05     Completed Date:  1993-10-05     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  197-203     Citation Subset:  IM    
Respiratory Failure Unit, General Hospital G. Papanicolaou, Aristotelian University of Thessaloniki, Greece.
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MeSH Terms
Hemodynamics / physiology*
Lung / blood supply*
Lung Diseases, Obstructive / physiopathology*,  therapy
Lung Volume Measurements*
Middle Aged
Positive-Pressure Respiration*
Pulmonary Gas Exchange / physiology*
Pulmonary Ventilation / physiology
Pulmonary Wedge Pressure / physiology
Respiratory Insufficiency / physiopathology*,  therapy

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

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