Document Detail

Inspiratory vs. expiratory pressure-volume curves to set end-expiratory pressure in acute lung injury.
MedLine Citation:
PMID:  16091965     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To study the effects of two levels of positive end-expiratory pressure (PEEP), 2 cm H(2)O above the lower inflection point of the inspiratory limb and equal to the point of maximum curvature on the expiratory limb of the pressure-volume curve, in gas exchange, respiratory mechanics, and lung aeration. DESIGN AND SETTING: Prospective clinical study in the intensive care unit and computed tomography ward of a university hospital. PATIENTS: Eight patients with early acute lung injury. INTERVENTIONS: Both limbs of the static pressure-volume curve were traced and inflection points calculated using a sigmoid model. During ventilation with a tidal volume of 6 ml/kg we sequentially applied a PEEP 2 cm H(2)O above the inspiratory lower inflection point (15.5+/-3.1 cm H(2)O) and a PEEP equal to the expiratory point of maximum curvature (23.5+/-4.1 cmH(2)O). MEASUREMENTS AND RESULTS: Arterial blood gases, respiratory system compliance and resistance and changes in lung aeration (measured on three computed tomography slices during end-expiratory and end-inspiratory pauses) were measured at each PEEP level. PEEP according to the expiratory point of maximum curvature was related to an improvement in oxygenation, increase in normally aerated, decrease in nonaerated lung volumes, and greater alveolar stability. There was also an increase in PaCO(2), airway pressures, and hyperaerated lung volume. CONCLUSIONS: High PEEP levels according to the point of maximum curvature of the deflation limb of the pressure-volume curve have both benefits and drawbacks.
Guillermo M Albaiceta; Luis H Luyando; Diego Parra; Rafael Menendez; Juan Calvo; Paula Rodríguez Pedreira; Francisco Taboada
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2005-08-10
Journal Detail:
Title:  Intensive care medicine     Volume:  31     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-10-13     Completed Date:  2006-01-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1370-8     Citation Subset:  IM    
Department of Intensive Medicine, Hospital Universitario Central de Asturias, Celestino Villamil s/n, 33006 Oviedo, Spain.
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MeSH Terms
Aged, 80 and over
Middle Aged
Positive-Pressure Respiration / methods*
Pulmonary Gas Exchange
Respiratory Distress Syndrome, Adult / mortality,  physiopathology,  therapy*
Tidal Volume
Tomography, X-Ray Computed

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

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