Two Methods of Setting Positive End-expiratory Pressure in Acute Lung Injury: An Experimental Computed Tomography Volumetric Study.
10.3346/jkms.2007.22.3.476
- Author:
Kyeongman JEON
1
;
Ik Soo JEON
;
Gee Young SUH
;
Man Pyo CHUNG
;
Won Jung KOH
;
Hojoong KIM
;
O Jung KWON
;
Dai Hee HAN
;
Myung Jin CHUNG
;
Kyung Soo LEE
Author Information
1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Korea. gysuh@smc.samsung.co.kr
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Acute Respiratory Distress Syndrome;
Positive-pressure Respiration;
Pressure-volume Curve;
Computed Tomography
- MeSH:
Animals;
Dogs;
Lung/pathology;
*Lung Injury;
Lung Volume Measurements/*methods;
Male;
Oxygen/metabolism;
Positive-Pressure Respiration/*methods;
Pressure;
Pulmonary Gas Exchange;
Radiography, Thoracic/methods;
Tomography, X-Ray Computed/*methods
- From:Journal of Korean Medical Science
2007;22(3):476-483
- CountryRepublic of Korea
- Language:English
-
Abstract:
This study was conducted to observe effects of two methods of setting positive endexpiratory pressure (PEEP) based on the pressure-volume (PV) curve. After lung injury was induced by oleic acid in six mongrel adult dogs, the inflation PV curve was traced and the lower inflection point (LIP) was measured. The 'PEEP(INF)' was defined as LIP+2 cmH2O. After recruitment maneuver to move the lung physiology to the deflation limb of PV curve, decremental PEEP was applied. The lowest level of PEEP that did not result in a significant drop in PaO2 was defined as the 'PEEP(DEF)'. Arterial blood gases, lung mechanics, hemodynamics, and lung volumes (measured on computed tomography during end-expiratory pause) were measured at PEEP of 0 cmH2O, PEEP(INF) and PEEP(DEF) sequentially. The median PEEP(INF) was 13.4 cm H2O (interquartile range, 12.5-14.3) and median PEEP(DEF) was 12.0 cm H2O (10.0-16.5) (p=0.813). PEEP(DEF) was associated with significantly higher PaO2 and lung volumes, and significantly lower shunt fraction and cardiac index when compared to PEEP(INF) (p<0.05). Setting the PEEP based on the deflation limb of the PV curve was useful in improving oxygenation and lung volumes in a canine lung injury model.
