Document Detail


Effects of positive end-expiratory pressure increments can be predicted by computer simulation based on a physiological profile in acute respiratory failure.
MedLine Citation:
PMID:  12541155     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We examined whether computer simulation predicts airway pressures after increments of positive end-expiratory pressure (PEEP) in acute respiratory failure. DESIGN AND SETTING: Prospective, nonrandomized comparative trial in an intensive care unit of a university hospital. PATIENTS: Twelve consecutive acute respiratory failure patients. INTERVENTIONS. PEEP increments from 0 to 2.5, 5, 7.5, 10, and 15 cm H(2)O. MEASUREMENTS AND RESULTS: A physiological profile comprising values for compliance, respiratory resistance and CO(2 )elimination as a function of tidal volume was established from a recording of ordinary breaths prior to increments of PEEP. Airway pressures and CO(2 )elimination were measured 30 s after resetting, pressures also after 10 min. Values from simulation of the resetting, based on the profile, were compared to measured values. The profiles indicated vast differences in physiology between the 12 subjects. Errors of simulation of airway pressures were nonsignificant or trivial up to PEEP levels of 10 cm H(2)O (95% of errors <3 cm H(2)O). After 10 min plateau pressure averaged 1.5 cm H(2)O lower than 30 s after resetting. At increments to PEEP 7.5, 10, and 15, CO(2 )elimination fell by on average 4%, 8%, and 11%, respectively. As tidal volume and respiratory rate was unchanged this was not predicted. CONCLUSIONS: On the basis of a simple lung model, simulation predicted effects of moderate increments of PEEP on airway pressures in patients with complex physiology.
Authors:
L Uttman; L Beydon; B Jonson
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Publication Detail:
Type:  Journal Article; Validation Studies     Date:  2003-01-22
Journal Detail:
Title:  Intensive care medicine     Volume:  29     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-02-20     Completed Date:  2003-06-20     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  226-32     Citation Subset:  IM    
Affiliation:
Department of Clinical Physiology, University Hospital, 22185, Lund, Sweden. Leif.Uttman@klinfys.lu.se
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Airway Resistance*
Breath Tests
Carbon Dioxide / analysis
Computer Simulation*
Humans
Linear Models*
Lung Compliance
Middle Aged
Models, Biological*
Positive-Pressure Respiration / methods*
Predictive Value of Tests
Prospective Studies
Respiratory Dead Space
Respiratory Insufficiency / etiology,  metabolism,  physiopathology,  therapy*
Tidal Volume
Time Factors
Treatment Outcome
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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