Document Detail


Positive end-expiratory pressure ventilation increases extravascular lung water due to a decrease in lung lymph flow.
MedLine Citation:
PMID:  16802485     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Positive end-expiratory pressure (PEEP) is used to improve gas exchange, increase functional residual capacity, recruit air spaces, and decrease pulmonary shunt in patients suffering from respiratory failure. The effect of PEEP on extravascular lung water (EVLW), however, is still not fully understood. This study was designed as a prospective laboratory experiment to evaluate the effects of PEEP on EVLW and pulmonary lymph flow (QL) under physiologic conditions. Twelve adult sheep were operatively prepared to measure haemodynamics of the systemic and pulmonary circulation, and to assess EVLW In addition, the lung lymphatic duct was cannulated and a tracheostomy performed. The animals were then mechanically ventilated in the awake-state without end-expiratory pressure (PEEP 0). After a two-hour baseline period, PEEP was increased to 10 cmH2O for the duration of two hours, and then reduced back to 0 cmH2O. Cardiopulmonary variables, QL, and arterial blood gases were recorded intermittently; EVLW was determined two hours after each change in PEEP. The increase in PEEP resulted in a decrease in QL (7 +/- 1 vs 5 +/- 1 ml/h) and an increase in EVLW (498 +/- 40 vs 630 +/- 58 ml; P<0.05 each) without affecting cardiac output. As PEEP was decreased back to baseline, QL increased significantly (5 +/- 1 vs 10 +/- 2 ml/h), whereas EVLW returned back to baseline. This study suggests that institution of PEEP produces a reversible increase in EVLW that is linked to a decrease in QL.
Authors:
D M Maybauer; P O Talke; M Westphal; M O Maybauer; L D Traber; P Enkhbaatar; N Morita; D L Traber
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Anaesthesia and intensive care     Volume:  34     ISSN:  0310-057X     ISO Abbreviation:  Anaesth Intensive Care     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-06-28     Completed Date:  2006-09-12     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0342017     Medline TA:  Anaesth Intensive Care     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  329-33     Citation Subset:  IM    
Affiliation:
Department of Anaesthesiology, Investigational Intensive Care Unit, The University of Texas Medical Branch, and Shriners Burns Hospital for Children at Galveston, USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Extravascular Lung Water / physiology*
Female
Hemodynamics
Lung*
Lymph / physiology*
Positive-Pressure Respiration*
Sheep

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