Intensive Care Medicine

, Volume 26, Issue 9, pp 1207–1214

Effect of PEEP on work of breathing in mechanically ventilated COPD patients

  • C. Guerin
  • J. Milic-Emili
  • G. Fournier

DOI: 10.1007/s001340051339

Cite this article as:
Guerin, C., Milic-Emili, J. & Fournier, G. Intensive Care Med (2000) 26: 1207. doi:10.1007/s001340051339


Objective: To study the effects of PEEP on the inspiratory work done per breath on the respiratory system (WI,rs) in patients with chronic obstructive pulmonary disease (COPD).¶Design: Physiological study.¶Setting: Fourteen-bed Medical ICU of a 1000-bed teaching tertiary hospital.¶Patients and participants: Ten patients with COPD intubated and mechanically ventilated for acute respiratory failure.¶Interventions: PEEP of 0 (ZEEP), ¶5, 10, and 15 cm H2O were applied randomly and measurements done at the end of a 15–20 min period.¶Measurements and results: Using the rapid airway occlusion technique during constant flow inflation, we partitioned WI,rs into its static and dynamic components. On ZEEP, the mean ± SD values of WI,rs amounted to 15.1 ± 5.7 cm H2O × l. With increasing PEEP, WI,rs was significantly reduced to 12.6 ± 5.7, 11.1 ± 4.1, and 10.4 ± 2.8 cm H2O × l at PEEP of 5, 10, and 15 cm H2O, respectively (P < 0.05). This reduction was entirely due to the decline of the work due to intrinsic PEEP (PEEPi) and was abolished when the applied PEEP counterbalanced PEEPi. The other components of WI,rs were not affected by PEEP. By increasing PEEP up to the level of PEEPi on ZEEP, no further increase in end-expiratory lung volume was observed.¶Conclusions: In COPD patients the application of PEEP levels close to PEEPi can substantially reduce WI,rs without promoting further dynamic pulmonary hyperinflation.

Key words Work of breathing Chronic obstructive pulmonary disease Mechanical ventilation Pulmonary hyperinflation Positive end-expiratory pressure 

Copyright information

© Springer-Verlag Berlin Heidelberg 2000

Authors and Affiliations

  • C. Guerin
    • 1
  • J. Milic-Emili
    • 3
  • G. Fournier
    • 2
  1. 1.Service de Réanimation Médicale et Assistance Respiratoire, Hôpital de la Croix-Rousse, 103 grande rue de la Croix-Rousse, 69004 Lyon, France e-mail: Tel.: + 33-4-72 07 17 62 Fax: + 33-4-72 07 17 74France
  2. 2.Service de Réanimation Médicale, Centre Hospitalier Lyon-Sud, Pierre Bénite, FranceFrance
  3. 3.Meakins-Christie laboratories, McGill University, Montreal, Quebec, CanadaCanada