Controlled ventilation with best positive end-expiratory pressure (PEEP) and high level PEEP in acute respiratory failure (ARF)

Intensive Care Medicine
F JardinA Margairaz

Abstract

We assessed hemodynamics, total lung and chest wall compliance (CT) and gas exchange using two different levels of PEEP during controlled ventilation in two different groups of patients with ARF; in the first group (Group 1, 12 patients) chest X-Rays showed a symmetrical pattern of bilateral alveolar infiltrates; in the second group (Group 2, 5 patients) chest X-Ray showed a asymmetrical pattern with unilateral lobar consolidation. A first level of PEEP (best PEEP = 9 +/- 3 cm H2O) produced an improvement in CT and in gas exchange with a slight decrease in cardiac index in both groups; but improvement in PaO2 (from 64 +/-33 to 122 +/- 76 torr, p less than 0.001 in Group 1, and from 76 +/- 39 to 91 +/- 33 torr, p less than 0.05 in Group 2) and decrease in QS/QT were not as well marked in Group 2 as i Group 1. A second level of PEEP (high level PEEP: 20 +/- 4 cm H2O) produced a sharp decrease in CT and required hemodynamic support in each case (blood volume expansion with or without Dopamine infusion) to maintain cardiac index within a normal range. In Group 1 this high level PEEP produced a greater improvement in gas exchange (PaO2 increased from 122 +/- 76 to 194 +/- 76, p less than 0.01) but in Group 2 it had a deleterious eff...Continue Reading

References

Feb 6, 1975·The New England Journal of Medicine·P M SuterM D Isenberg
Mar 3, 1977·The New England Journal of Medicine·W M Zapol, M T Snider
Jan 1, 1976·International Anesthesiology Clinics·W M ZapolM Rie
May 1, 1980·Intensive Care Medicine·F JardinA Margairaz
Sep 1, 1960·Journal of Applied Physiology·J L WHITTENBERGERH G BORST

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Citations

Sep 25, 2012·Expert Opinion on Drug Metabolism & Toxicology·Sarah C CampbellCatherine Mt Sherwin
Apr 1, 1991·Chest·F H HawkerA E Southee

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