Document Detail


Positive end expiratory pressure and expiratory flow limitation: a model study.
MedLine Citation:
PMID:  11804239     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients suffering from chronic obstructive pulmonary diseases, frequently exhibit expiratory airflow limitation. We propose a mathematical model describing the mechanical behavior of the ventilated respiratory system. This model has to simulate applied positive end-expiratory pressure (PEEP) effects during expiration, a process used by clinicians to improve airflow. The proposed model consists of a nonlinear two-compartment system. One of the compartments represents the collapsible airways and mimics its dynamic compression, the other represents the lung and chest wall compartment. For all clinical conditions tested (n=16), the mathematical model simulates the removal of expiratory airflow limitation at PEEP lower than 70-80% of intrinsic end-expiratory pressure (PEEPi), i.e. the end-expiratory alveolar pressure (PAet) without PEEP. It also shows the presence of an optimal PEEP. The optimal PEEP contributes to decrease PAet from 7.4+/-0.9 (SD) to 5.4+/-0.9 hPa (p < 0.0001; mild flow limitation) and from 11.8+/-1.1 to 7.8+/-0.7 hPa (p < 0.0001; severe flow limitation). Resistance of the collapsible compartment is decreased from 53+/-7 to 8.2+/-5.9 hPa.L(-1).s (p < 0.0001; mild flow limitation) and from 80+/-11 to 6.9+/-5.4 hPa.L(-1).s (p < 0.0001; severe flow limitation). This simplistic mathematical model gives a plausible explanation of the expiratory airflow limitation removal with PEEP and a rationale to the practice of PEEP application to airflow limited patients.
Authors:
S Khirani; L Biot; A Eberhard; P Baconnier
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta biotheoretica     Volume:  49     ISSN:  0001-5342     ISO Abbreviation:  Acta Biotheor.     Publication Date:  2001  
Date Detail:
Created Date:  2002-01-23     Completed Date:  2002-07-18     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0421520     Medline TA:  Acta Biotheor     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  277-90     Citation Subset:  IM    
Affiliation:
Laboratoire Techniques en Imagerie Modélisation et Cognition (Institut IMAG), Faculté de Médecine, La Tronche, France.
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MeSH Terms
Descriptor/Qualifier:
Airway Resistance / physiology*
Forced Expiratory Flow Rates / physiology
Humans
Models, Theoretical*
Nonlinear Dynamics*
Positive-Pressure Respiration / statistics & numerical data*
Pulmonary Alveoli / physiopathology
Pulmonary Disease, Chronic Obstructive / physiopathology*

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