Document Detail

Expiratory flow limitation and intrinsic positive end-expiratory pressure at zero positive end-expiratory pressure in patients with adult respiratory distress syndrome.
MedLine Citation:
PMID:  10806160     Owner:  NLM     Status:  MEDLINE    
It has been suggested that in patients with adult respiratory distress syndrome (ARDS), intrinsic positive end-expiratory pressure (PEEPi) is generated by a disproportionate increase in expiratory flow resistance. Using the negative expiratory pressure (NEP) technique, we assessed whether expiratory flow limitation (EFL) and PEEPi were present at zero PEEP in 10 semirecumbent, mechanically ventilated ARDS patients. Because bronchodilators may decrease airway resistance, we also investigated the effect of nebulized salbutamol on EFL, PEEPi, and respiratory mechanics in these patients, and in seven patients we measured the latter variables in the supine position as well. In the semirecumbent position, eight of the 10 ARDS patients exhibited tidal EFL, ranging from 5 to 37% of the control tidal volume (VT), whereas PEEPi was present in all 10 subjects, ranging from 0.4 cm H(2)O to 7.7 cm H(2)O. The onset of EFL was heralded by a distinct inflection point on the expiratory flow-volume curve, which probably reflected small-airway closure. Administration of salbutamol had no statistically significant effect on PEEPi, EFL (as %VT), or respiratory mechanics. EFL (%VT) and PEEPi were significantly higher in the supine position than in the semirecumbent position, whereas the other respiratory variables did not change. Our results suggest that in the absence of externally applied PEEP, most ARDS patients exhibit EFL associated with small-airway closure and a concomitant PEEPi.
A Koutsoukou; A Armaganidis; C Stavrakaki-Kallergi; T Vassilakopoulos; A Lymberis; C Roussos; J Milic-Emili
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  161     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2000 May 
Date Detail:
Created Date:  2000-06-21     Completed Date:  2000-06-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1590-6     Citation Subset:  AIM; IM    
Critical Care Department, Evangelismos General Hospital, Medical School, University of Athens, Athens, Greece.
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MeSH Terms
Aged, 80 and over
Airway Resistance
Albuterol / administration & dosage
Bronchodilator Agents / administration & dosage
Middle Aged
Positive-Pressure Respiration*
Positive-Pressure Respiration, Intrinsic*
Pulmonary Ventilation*
Respiratory Distress Syndrome, Adult / physiopathology,  therapy*
Supine Position
Reg. No./Substance:
0/Aerosols; 0/Bronchodilator Agents; 18559-94-9/Albuterol

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

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