“The Use of Positive End-Expiratory Pressure in Mechanical Ventilation”

Acosta, Pilar; Santisbon, Edgardo; Varon, Joseph

doi:10.1016/j.ccc.2006.12.012

Cited by 48 publications

(43 citation statements)

References 35 publications

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“…Of these, PEEP has been known for some time to increase oxygenation in the setting of acute respiratory failure [24]. For patients with ARDS, the application of PEEP improves intrapulmonary shunts (despite clinical controversy), assists respiratory muscles by reducing the force needed for respiration, increases functional residual volume, and remobilizes collapsed alveoli to increase oxygenation [25]. Moreover, PEEP is also known to reduce the loss of surfactant and prevent lung collapse [26].…”

Section: Discussionmentioning

confidence: 99%

The effect of positive-end expiratory pressure on oxygenation during high frequency jet ventilation and conventional mechanical ventilation in the rabbit model of acute lung injury

Bang

Choi

2012

Korean J Anesthesiol

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BackgroundThe use of positive end expiratory pressure (PEEP) in patients with acute lung injury (ALI) improves arterial oxygenation by alleviating pulmonary shunting, helping the respiratory muscles to decrease the work of breathing, decreasing the rate of infiltrated and atelectatic tissues, and increasing functional residual capacity. In a rabbit model of saline lavage-induced ALI, we examined the effects of PEEP on gas exchange, hemodynamics, and oxygenation during high frequency jet ventilation (HFJV), and then compared these parameters with those during conventional mechanical ventilation (CMV).MethodsTwelve rabbits underwent repeated saline lavage to create ALI. The animals were divided in 2 groups: 1) Group CMV (n = 6), and 2) Group HFJV (n = 6). In both groups, we applied 2 levels of PEEP (5 cmH2O and 10 cmH2O) and then measured the arterial blood gas, mixed venous blood gas, and hemodynamic parameters.ResultsWith administration of PEEP of either 5 cmH2O or 10 cmH2O, the arterial oxygen content of both groups was increased, although without statistically significant differences between groups. On the contrary, the arterial carbon dioxide content was significantly decreased in the HFJV group, as compared with the CMV group, during the entire experiment. Furthermore, there was significant decreases in mean arterial pressures in both groups with a PEEP of 10 cmH2O.ConclusionsThe application of PEEP in rabbits with ALI effectively improves oxygenation in either HFJV or CMV.

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Section: Discussionmentioning

confidence: 99%

The effect of positive-end expiratory pressure on oxygenation during high frequency jet ventilation and conventional mechanical ventilation in the rabbit model of acute lung injury

Bang

Choi

2012

Korean J Anesthesiol

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“…High levels of PEEP have been shown to produce barotrauma (7) and to be detrimental to hemodynamics (8). Increased intrathoracic pressure can decrease venous return and restrict cardiac filling, which may result in reduced cardiac output and hypotension.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, a relevant flow of oxygen to the lungs of the patient cannot be avoided (6). In a completely obstructed upper airway, this oxygen flow will inevitably create a positive end‐expiratory pressure (PEEP) which can lead to barotrauma (7) and hemodynamic instability (8).…”

Section: Introductionmentioning

confidence: 99%

The importance of flow and pressure release in emergency jet ventilation devices

Hamaekers

Borg

Enk

2009

Pediatric Anesthesia

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“…Although collapsed alveoli may be properly perfused they contribute to pulmonary shunt because they do not contribute to ventilation. As PEEP is applied, more alveoli are recruited, which means there is more aerated surface area for gas exchange, which causes a decrease in shunt [27,28]. Thus, if it is possible to estimate changes in shunt, then the question is whether the diffusion model can work backwards to predict changes in CO?…”

Section: Model Development and Methodsmentioning

confidence: 99%

Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients

Sundaresan

Chase

Hann

2010

BioMedical Engineering OnLine

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The application of positive end expiratory pressure (PEEP) in mechanically ventilated (MV) patients with acute respiratory distress syndrome (ARDS) decreases cardiac output (CO). Accurate measurement of CO is highly invasive and is not ideal for all MV critically ill patients. However, the link between the PEEP used in MV, and CO provides an opportunity to assess CO via MV therapy and other existing measurements, creating a CO measure without further invasiveness.This paper examines combining models of diffusion resistance and lung mechanics, to help predict CO changes due to PEEP. The CO estimator uses an initial measurement of pulmonary shunt, and estimations of shunt changes due to PEEP to predict CO at different levels of PEEP. Inputs to the cardiac model are the PV loops from the ventilator, as well as the oxygen saturation values using known respiratory inspired oxygen content. The outputs are estimates of pulmonary shunt and CO changes due to changes in applied PEEP. Data from two published studies are used to assess and initially validate this model.The model shows the effect on oxygenation due to decreased CO and decreased shunt, resulting from increased PEEP. It concludes that there is a trade off on oxygenation parameters. More clinically importantly, the model also examines how the rate of CO drop with increased PEEP can be used as a method to determine optimal PEEP, which may be used to optimise MV therapy with respect to the gas exchange achieved, as well as accounting for the impact on the cardiovascular system and its management.

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“The Use of Positive End-Expiratory Pressure in Mechanical Ventilation”

Cited by 48 publications

References 35 publications

The effect of positive-end expiratory pressure on oxygenation during high frequency jet ventilation and conventional mechanical ventilation in the rabbit model of acute lung injury

The effect of positive-end expiratory pressure on oxygenation during high frequency jet ventilation and conventional mechanical ventilation in the rabbit model of acute lung injury

The importance of flow and pressure release in emergency jet ventilation devices

Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients

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