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01-04-2009 | Experimental

A comparison of methods to identify open-lung PEEP

Authors: Maria Paula Caramez, Robert M. Kacmarek, Mohamed Helmy, Eriko Miyoshi, Atul Malhotra, Marcelo B. P. Amato, R. Scott Harris

Published in: Intensive Care Medicine | Issue 4/2009

Abstract

Purpose

Many methods exist in the literature for identifying PEEP to set in ARDS patients following a lung recruitment maneuver (RM). We compared ten published parameters for setting PEEP following a RM.

Methods

Lung injury was induced by bilateral lung lavage in 14 female Dorset sheep, yielding a PaO₂ 100–150 mmHg at F_IO₂ 1.0 and PEEP 5 cmH₂O. A quasi-static P–V curve was then performed using the supersyringe method; PEEP was set to 20 cmH₂O and a RM performed with pressure control ventilation (inspiratory pressure set to 40–50 cmH₂O), until PaO₂ + PaCO₂ > 400 mmHg. Following the RM, a decremental PEEP trial was performed. The PEEP was decreased in 1 cmH₂O steps every 5 min until 15 cmH₂O was reached. Parameters measured during the decremental PEEP trial were compared with parameters obtained from the P–V curve.

Results

For setting PEEP, maximum dynamic tidal respiratory compliance, maximum PaO₂, maximum PaO₂ + PaCO₂, and minimum shunt calculated during the decremental PEEP trial, and the lower Pflex and point of maximal compliance increase on the inflation limb of the P–V curve (Pmci,i) were statistically indistinguishable. The PEEP value obtained using the deflation upper Pflex and the point of maximal compliance decrease on the deflation limb were significantly higher, and the true inflection point on the inflation limb and minimum PaCO₂ were significantly lower than the other variables.

Conclusion

In this animal model of ARDS, dynamic tidal respiratory compliance, maximum PaO₂, maximum PaO₂ + PaCO₂, minimum shunt, inflation lower Pflex and Pmci,i yield similar values for PEEP following a recruitment maneuver.

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Title: A comparison of methods to identify open-lung PEEP
Authors: Maria Paula Caramez
Robert M. Kacmarek
Mohamed Helmy
Eriko Miyoshi
Atul Malhotra
Marcelo B. P. Amato
R. Scott Harris
Publication date: 01-04-2009
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 4/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-009-1412-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A comparison of methods to identify open-lung PEEP

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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