Document Detail


Hyperinflation and intrinsic positive end-expiratory pressure: less room to breathe.
MedLine Citation:
PMID:  19141987     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Clinically, the symptoms and limited exercise capabilities of patients with chronic obstructive pulmonary disease (COPD) correlate better with changes in lung volumes than with airflow measurements. The realization of the clinical importance of hyperinflation has been overshadowed for decades by the use of forced expiratory volume during 1 s (FEV(1)) and the ratio of the FEV(1) to the forced expiratory vital capacity (FEV(1)/FVC) to categorize the severity and progression of COPD. Hyperinflation is defined as an elevation in the end-expiratory lung volume or functional residual capacity. When severe hyperinflation encroaches upon inspiratory capacity and limits vital capacity, it results in elevated intrinsic positive end-expiratory pressure (PEEPi) that places the diaphragm at a mechanical disadvantage and increases the work of breathing. Severe hyperinflation is the major physiologic cause of the resulting hypercarbic respiratory failure and patients' inability to transition (i.e. wean) from mechanical ventilatory support to spontaneous breathing. This paper reviews the basic physiologic principles of hyperinflation and its clinical manifestations as demonstrated by PEEPi. Also reviewed are the adverse effects of hyperinflation and PEEPi in critically ill patients with COPD, and methods for minimizing or counterbalancing these effects.
Authors:
Bruce P Krieger
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2009-01-10
Journal Detail:
Title:  Respiration; international review of thoracic diseases     Volume:  77     ISSN:  1423-0356     ISO Abbreviation:  Respiration     Publication Date:  2009  
Date Detail:
Created Date:  2009-04-06     Completed Date:  2009-07-17     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0137356     Medline TA:  Respiration     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  344-50     Citation Subset:  IM    
Copyright Information:
Copyright 2009 S. Karger AG, Basel.
Affiliation:
Miller School of Medicine, University of Miami, Miami, Fla., USA. bronchobruce@pol.net
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MeSH Terms
Descriptor/Qualifier:
Exercise / physiology
Humans
Intensive Care
Positive-Pressure Respiration, Intrinsic / physiopathology*
Pulmonary Disease, Chronic Obstructive / physiopathology*,  therapy
Pulmonary Ventilation*
Comments/Corrections
Comment In:
Respiration. 2009;77(3):256-8   [PMID:  19346761 ]

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


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