Effects of positive end-expiratory pressure on dead space and its partitions in acute lung injury

Beydon, L.; Uttman, L.; Rawal, R.; Jonson, B.
September 2002
Intensive Care Medicine;Sep2002, Vol. 28 Issue 9, p1239
Academic Journal
Objective. A large tidal volume (VT) and lung collapse and re-expansion may cause ventilator-induced lung injury (VILI) in acute lung injury (ALI). A low VT and a positive end-expiratory pressure (PEEP) can prevent VILI, but the more VT is reduced, the more dead space (VD) compromises gas exchange. We investigated how physiological, airway and alveolar VD varied with PEEP and analysed possible links to respiratory mechanics. Setting. Medical and surgical intensive care unit (ICU) in a university hospital. Design. Prospective, non-randomised comparative trial. Patients. Ten consecutive ALI patients. Intervention. Stepwise increases in PEEP from zero to 15 cmH2O. Measurements and results. Lung mechanics and VD were measured at each PEEP level. Physiological VD was 41–64% of VT at zero PEEP and increased slightly with PEEP due to a rise in airway VD. Alveolar VD was 11–38% of VT and did not vary systematically with PEEP. However, in individual patients a decrease and increase of alveolar VD paralleled a positive or negative response to PEEP with respect to oxygenation (shunt), respectively. VD fractions were independent of respiratory resistance and compliance. Conclusions. Alveolar VD is large and does not vary systematically with PEEP in patients with various degrees of ALI. Individual measurements show a diverse response to PEEP. Respiratory mechanics were of no help in optimising PEEP with regard to gas exchange.


Related Articles

  • Aspiration of dead space allows isocapnic low tidal volume ventilation in acute lung injury. Relationships to gas exchange and mechanics. De Robertis, E.; Servillo, G.; Tufano, R.; Jonson, B. // Intensive Care Medicine;Sep2001, Vol. 27 Issue 9, p1496 

    Objective: In acute lung injury (ALI) mechanical ventilation damages lungs. We hypothesised that aspiration and replacement of dead space during expiration (ASPIDS) allows normocapnic ventilation at higher end-expiratory pressure (PEEP) and reduced tidal volume (VT), peak and plateau pressures...

  • Effect of prone position on hepato-splanchnic hemodynamics in acute lung injury. Matejovic, Martin; Rokyta Jr., Richard; Radermacher, Peter; Krouzecky, Ales; Sramek, Vladimir; Novak, Ivan // Intensive Care Medicine;Dec2002, Vol. 28 Issue 12, p1750 

    Objective. To evaluate the effects of prone position on hepato-splanchnic hemodynamics, metabolism and gut mucosal energy balance. Design. Prospective clinical study. Setting. Medical intensive care unit in a university hospital. Patients. Eleven hemodynamically stable patients with acute lung...

  • "Ideal PEEP" is superior to high dose partial liquid ventilation with low PEEP in experimental acute lung injury. Wolf, Steffen; Lohbrunner, Hansjoerg; Busch, Thilo; Deja, Maria; Weber-Carstens, Steffen; Donaubauer, Bernd; Sterner-Kock, Anja; Kaisers, Udo // Intensive Care Medicine;Dec2001, Vol. 27 Issue 12, p1937 

    Objective: To determine the effects of a high dose partial liquid ventilation (PLV) approximating the amount of the functional residual capacity (FRC) with low levels of positive end-expiratory pressure (PEEP) compared to a lung-protective strategy with volume-controlled mechanical ventilation...

  • Year in review 2010: Critical Care -- respirology. Fanelli, Vito; Zhang, Haibo; Slutsky, Arthur S. // Critical Care;2011, Vol. 15 Issue 6, p1 

    In this review, 21 original papers published last year in the respirology and critical care sections of Critical Care are classified and analyzed in the following categories: mechanical ventilation, lung recruitment maneuvers, and weaning; the role of positive end-expiratory pressure in acute...

  • Mask mechanics and leak dynamics during noninvasive pressure support ventilation: a bench study. Schettino, Guilherme; Tucci, Mauro; Sousa, Rogério; Barbas, Carmen; Amato, Marcelo; Carvalho, Carlos // Intensive Care Medicine;Dec2001, Vol. 27 Issue 12, p1887 

    Objective: To study the mask mechanics and air leak dynamics during noninvasive pressure support ventilation. Setting: Laboratory of a university hospital. Design: A facial mask was connected to a mannequin head that was part of a mechanical respiratory system model. The mask fit pressure...

  • Ineffective efforts during mechanical ventilation: the brain wants, the machine declines. Georgopoulos, Dimitris // Intensive Care Medicine;May2012, Vol. 38 Issue 5, p738 

    The article presents the author's views of mechanical ventilation theraphy. It specifically refers to several studies in this regard. According to the author, medical professional can identify IE by following a standard. The author says that the standard is either to insert an esophageal balloon...

  • Comparative bench study of triggering, pressurization, and cycling between the home ventilator VPAP II and three ICU ventilators. Tassaux, Didier; Strasser, Susannah; Fonseca, Silvana; Dalmas, Eric; Jolliet, Philippe // Intensive Care Medicine;Sep2002, Vol. 28 Issue 9, p1254 

    Objective. To compare triggering, pressurization, and cycling of the home ventilator VPAP II with those of three ICU ventilators (Evita 4, Galileo, and Servo 300). Design and setting. Two-compartment lung model study in a research laboratory, university hospital. Methods. One compartment was...

  • Put breath in without passing out. Barnard, Keith // GP: General Practitioner;5/5/2003, p95 

    This article provides information related to a product used for resuscitation. One of the more unwelcome consequences of this dedication to one's calling is the need to carry out mouth-to-mouthresuscitation from time to time. The hapless subjects are frequently hirsute, and the beard or...

  • rescue breathing. Peters, Michael // BMA A-Z Family Medical Encyclopedia;2004, p656 

    An encyclopedia entry for the term "rescue breathing" is presented. The term, which was known as artificial respiration, refers to the forced introduction of air into the lungs of someone with stopped breathing or without adequate breathing. Rescue breathing can be given mouth-to-mouth or...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics