1996
DOI: 10.1183/09031936.96.09061283
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Intrinsic PEEP and cardiopulmonary interaction in patients with COPD and acute ventilatory failure

Abstract: Intrinsic PEEP and cardiopulmonary interaction in patients with COPD and acute ventilatory failure. V.M. Ranieri, M. Dambrosio, N. Brienza. ERS Journals Ltd 1996. ABSTRACT: Deviation of end-expiratory lung volume from the elastic equilibrium volume of the respiratory system is recognized as a cardinal feature in mechanically-ventilated patients with severe chronic obstructive pulmonary disease (COPD) and acute ventilatory failure (AVF). The presence of dynamic hyperinflation implies that alveolar pressure rem… Show more

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Cited by 66 publications
(45 citation statements)
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“…The increase in lung volume may reduce venous return, directly through compression of the vena cava and right heart, and indirectly through an increase in right atrial pressure, decreasing the pressure gradient for venous return. 10,14 The effects of nasal CPAP on the lung parenchyma of stable COPD patients has been assessed via high-resolution computed tomography. In a recently published study, Holanda et al 28 obtained high-resolution computed tomog- Measurement of R aw may help distinguish airway obstruction due to intrinsic narrowing of the airway by mucus hypersecretion and bronchial wall inflammation (eg, chronic bronchitis) or to the loss of lung elastic recoil (eg, emphysema).…”
Section: Discussionmentioning
confidence: 99%
See 1 more Smart Citation
“…The increase in lung volume may reduce venous return, directly through compression of the vena cava and right heart, and indirectly through an increase in right atrial pressure, decreasing the pressure gradient for venous return. 10,14 The effects of nasal CPAP on the lung parenchyma of stable COPD patients has been assessed via high-resolution computed tomography. In a recently published study, Holanda et al 28 obtained high-resolution computed tomog- Measurement of R aw may help distinguish airway obstruction due to intrinsic narrowing of the airway by mucus hypersecretion and bronchial wall inflammation (eg, chronic bronchitis) or to the loss of lung elastic recoil (eg, emphysema).…”
Section: Discussionmentioning
confidence: 99%
“…11,12 Applied PEEP above 10 cm H 2 O increases hyperinflation and worsens respiratory mechanics, muscle activity, and hemodynamics. 13,14 Given the few and contradictory results of studies on the influence of CPAP in patients with stable severe airway obstruction, we investigated the impact and duration of impact of CPAP on hyperinflation and R aw in patients with stable COPD.…”
Section: Introductionmentioning
confidence: 99%
“…1,2 Theoretically, patients with greater bronchial obstruction should exhibit greater limitations in exercise; however, this does not occur in clinical practice, where patients with a lesser degree of obstruction may exhibit greater limitations. This indicates the presence of multiple mechanisms involved in the development of these limitations.…”
Section: Introductionmentioning
confidence: 99%
“…Pulmonary hyperinflation also has important cardiovascular consequences, which have recently been reviewed [29]. Briefly, large changes in intrathoracic pressures during the respiratory cycle profoundly affect venous return, right cardiac function, and cardiac output in general.…”
Section: Consequences Of Pulmonary Hyperinflationmentioning
confidence: 99%
“…However, high levels of PEEPi impair cardiac filling and reduce cardiac output, systemic blood pressure and oxygen transport [18,29]. Furthermore, the dynamic hyperinflation associated with large VT may unduly raise the end-inflation pressure, enhancing the risk of alveolar distension and disruption (barotrauma), particularly in patients with acute exacerbation of COPD [53] or asthma [54,55].…”
Section: Controlled Mechanical Ventilation (Cmv)mentioning
confidence: 99%