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Inspiratory pressure-volume curves at different positive end-expiratory pressure levels in patients with ALI/ARDS

Background: In lung protective strategy, positive end‐expiratory pressure (PEEP) slightly higher than the Pflex (the airway pressure corresponding to the lower inflection point (LIP) on the inspiratory pressure–volume (P‐V) curve measured with ZEEP) is generally recommended. However, this method to...

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Published in:Acta anaesthesiologica Scandinavica 2001-11, Vol.45 (10), p.1255-1261
Main Authors: Nagano, O., Tokioka, H., Ohta, Y., Goto, K., Katayama, H., Hirakawa, M.
Format: Article
Language:English
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Summary:Background: In lung protective strategy, positive end‐expiratory pressure (PEEP) slightly higher than the Pflex (the airway pressure corresponding to the lower inflection point (LIP) on the inspiratory pressure–volume (P‐V) curve measured with ZEEP) is generally recommended. However, this method to determine optimal PEEP lacks a theoretical background and there is no clinical report that investigated how the P‐V relationship would be with such PEEP. Therefore, we measured inspiratory P‐V curves at different PEEP levels to increase our knowledge about the inspiratory P‐V curve with PEEP. Methods: In eight consecutive patients with ALI/ARDS, inspiratory P‐V curves were repeatedly measured at different PEEP levels by low flow inflation technique and LIP was assessed in all inspiratory P‐V curves. Afterwards, the minimum PEEP level at which LIP was not identifiable (PEEPLIP(−)) was determined and the relationship between Pflex and PEEPLIP(−) was investigated. Results: P flex and PEEPLIP(−) could be determined in all patients. Pflex was 9.4±2.0 cmH2O (range: 7 to 12 cmH2O) and PEEPLIP(−) was 7.9±1.6 cmH2O (range: 5 to 10 cmH2O) (mean±SD, P=0.0877). PEEPLIP(−) was lower than the Pflex in five patients, and significantly lower than the Pflex+ 2 cmH2O (P=0.0024). Conclusion: From the analysis of inspiratory P‐V curves at different PEEP levels, PEEP 2 cmH2O higher than the Pflex may not be necessary to prevent cyclic collapse and reopening of alveoli, at least in some ALI/ARDS patients. Further studies are needed to confirm this preliminary result.
ISSN:0001-5172
1399-6576
DOI:10.1034/j.1399-6576.2001.451014.x