Document Detail

Lung recruitment and positive end-expiratory pressure have different effects on CO2 elimination in healthy and sick lungs.
MedLine Citation:
PMID:  20705790     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: We studied the effects that the lung recruitment maneuver (RM) and positive end-expiratory pressure (PEEP) have on the elimination of CO(2) per breath (Vtco(2,br)). METHODS: In 7 healthy and 7 lung-lavaged pigs at constant ventilation, PEEP was increased from 0 to 18 cm H(2)O and then decreased to 0 in steps of 6 cm H(2)O every 10 minutes. Cycling RMs with plateau pressure/PEEP of 40/20 (healthy) and 50/25 (lavaged) cm H(2)O were applied for 2 minutes between 18-PEEP steps. Volumetric capnography, respiratory mechanics, blood gas, and hemodynamic data were recorded. RESULTS: In healthy lungs before the RM, Vtco(2,br) was inversely proportional to PEEP decreasing from 4.0 (3.6-4.4) mL (median and interquartile range) at 0-PEEP to 3.1 (2.8-3.4) mL at 18-PEEP (P < 0.05). After the RM, Vtco(2,br) increased from 3.3 (3-3.6) mL at 18-PEEP to 4.0 (3.5-4.5) mL at 0-PEEP (P < 0.05). In lavaged lungs before the RM, Vtco(2,br) increased initially from 2.0 (1.7-2.3) mL at 0-PEEP to 2.6 (2.2-3) mL at 12-PEEP (P < 0.05) but then decreased to 2.4 (2-2.8) mL when PEEP was increased further to 18 cm H(2)O (P < 0.05). After the RM, the highest Vtco(2,br) of 2.9 (2.1-3.7) mL was observed at 12-PEEP and then decreased to 2.5 (1.9-3.1) mL at 0-PEEP (P < 0.05). Vtco(2,br) was directly related to changes in lung perfusion, the area of gas exchange, and alveolar ventilation but inversely related to changes in dead space. CONCLUSIONS: CO(2) elimination by the lungs was dependent on PEEP and recruitment and showed major differences between healthy and lavaged lungs.
Gerardo Tusman; Stephan H Bohm; Fernando Suarez-Sipmann; Adriana Scandurra; Göran Hedenstierna
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-08-12
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  111     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-27     Completed Date:  2010-10-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  968-77     Citation Subset:  AIM; IM    
Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina.
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MeSH Terms
Blood Gas Analysis / methods
Bronchoalveolar Lavage / methods
Carbon Dioxide / analysis*
Exhalation / physiology*
Lung / physiology*
Lung Diseases / physiopathology*
Lung Volume Measurements / methods
Positive-Pressure Respiration / methods*
Pulmonary Gas Exchange / physiology
Random Allocation
Respiratory Mechanics / physiology*
Reg. No./Substance:
124-38-9/Carbon Dioxide

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