Advertisement

Intensive Care Medicine

, Volume 29, Issue 2, pp 226–232 | Cite as

Effects of positive end-expiratory pressure increments can be predicted by computer simulation based on a physiological profile in acute respiratory failure

  • L. UttmanEmail author
  • L. Beydon
  • B. Jonson
Original

Abstract

Objective

We examined whether computer simulation predicts airway pressures after increments of positive end-expiratory pressure (PEEP) in acute respiratory failure.

Design and setting

Prospective, nonrandomized comparative trial in an intensive care unit of a university hospital.

Patients

Twelve consecutive acute respiratory failure patients.

Interventions

PEEP increments from 0 to 2.5, 5, 7.5, 10, and 15 cmH2O.

Measurements and results

A physiological profile comprising values for compliance, respiratory resistance and CO2 elimination as a function of tidal volume was established from a recording of ordinary breaths prior to increments of PEEP. Airway pressures and CO2 elimination were measured 30 s after resetting, pressures also after 10 min. Values from simulation of the resetting, based on the profile, were compared to measured values. The profiles indicated vast differences in physiology between the 12 subjects. Errors of simulation of airway pressures were nonsignificant or trivial up to PEEP levels of 10 cmH2O (95% of errors <3 cmH2O). After 10 min plateau pressure averaged 1.5 cmH2O lower than 30 s after resetting. At increments to PEEP 7.5, 10, and 15, CO2 elimination fell by on average 4%, 8%, and 11%, respectively. As tidal volume and respiratory rate was unchanged this was not predicted.

Conclusions

On the basis of a simple lung model, simulation predicted effects of moderate increments of PEEP on airway pressures in patients with complex physiology.

Keywords

Respiratory insufficiency Acute lung injury Respiratory dead space Pulmonary gas exchange Mechanics Artificial ventilation 

References

  1. 1.
    Matamis D, Lemaire F, Harf A, Teisseire B, Brun-Buisson C (1984) Redistribution of pulmonary blood flow induced by positive end-expiratory pressure and dopamine infusion in acute respiratory failure. Am Rev Respir Dis 129:39–44PubMedGoogle Scholar
  2. 2.
    Jansson L, Jonson B (1972) A theoretical study on flow patterns of ventilators. Scand J Respir Dis 53:237–246PubMedGoogle Scholar
  3. 3.
    Uttman L, Sigurdsson S, Jonson B (1999) Computer simulation: a guideline in ventilator setting in severe lung disease. Crit Care 3 [Suppl 1]:A37Google Scholar
  4. 4.
    Uttman L, Jonson B (2002) Computer-aided ventilator resetting is feasible on the basis of a physiological profile. Acta Anaesthesiol Scand 46:289–296PubMedGoogle Scholar
  5. 5.
    Jonson B, Richard JC, Straus C, Mancebo J, Lemaire F, Brochard L (1999) Pressure-volume curves and compliance in acute lung injury: evidence of recruitment above the lower inflection point. Am J Respir Crit Care Med 159:1172–1178PubMedGoogle Scholar
  6. 6.
    Beydon L, Uttman L, Rawal R, Jonson B (2002) Effects of positive end-expiratory pressure on dead space and its partitions in acute lung injury. Intensive Care Med 28:1239–1245PubMedGoogle Scholar
  7. 7.
    Svantesson C, Drefeldt B, Jonson B (1997) The static pressure-volume relationhip of the respiratory system determined with a computer-controlled ventilator. Clin Physiol 17:419–430Google Scholar
  8. 8.
    Taskar V, John J, Larsson A, Wetterberg T, Jonson B (1995) Dynamics of carbon dioxide elimination following ventilator resetting. Chest 108:196–202PubMedGoogle Scholar
  9. 9.
    Rohrer F (1915) Der Strömungswiderstand in den menschlichen Atemwegen und der Einfluss der unregelmässigen Verzweigung des Bronchialsystems auf den Atmungsverlauf. Arch Gesamte Physiol 162:225–299Google Scholar
  10. 10.
    Jonson B, Beydon L, Brauer K, Månsson C, Valind S, Grytzell H (1993) Mechanics of respiratory system in healthy anesthetized humans with emphasis on viscoelastic properties. J Appl Physiol 75:132–140PubMedGoogle Scholar
  11. 11.
    Beydon L, Svantesson C, Brauer K, Lemaire F, Jonson B (1996) Respiratory mechanics in patients ventilated for critical lung disease. Eur Respir J 9:262–273PubMedGoogle Scholar
  12. 12.
    Ranieri VM, Zhang H, Mascia L, Aubin M, Lin CY, Mullen JB, Grasso S, Binnie M, Volgyesi GA, Eng P, Slutsky AS (2000) Pressure-time curve predicts minimally injurious ventilatory strategy in an isolated rat lung model. Anesthesiology 93:1320–1328Google Scholar
  13. 13.
    Briscoe WA, Dubois AB (1958) The relationship between airway resistance, airway conductance and lung volume in subjects of different age and body size. J Clin Invest 37:1279–1285Google Scholar
  14. 14.
    Fletcher R, Jonson B, Cumming G, Brew J (1981) The concept of dead space with special reference to the single breath test for carbon dioxide. Br J Anaesth 53:77–88PubMedGoogle Scholar
  15. 15.
    ARDS Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308PubMedGoogle Scholar
  16. 16.
    Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, Takagaki TY, Carvalho CR (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338:347–354PubMedGoogle Scholar
  17. 17.
    Ranieri VM, Eissa NT, Corbeil C, Chasse M, Braidy J, Matar N, Milic-Emili J (1991) Effects of positive end-expiratory pressure on alveolar recruitment and gas exchange in patients with the adult respiratory distress syndrome. Am Rev Respir Dis 144:544–551PubMedGoogle Scholar
  18. 18.
    Larsson A, Gilbert JT, Bunegin L, Gelineau J, Smith RB (1992) Pulmonary effects of body position, PEEP, and surfactant depletion in dogs. Acta Anaesthesiol Scand 36:38–45PubMedGoogle Scholar
  19. 19.
    Nieman GF, Paskanik AM, Bredenberg CE (1988) Effect of positive end-expiratory pressure on alveolar capillary perfusion. J Thorac Cardiovasc Surg 95:712–716PubMedGoogle Scholar
  20. 20.
    Kanarek DJ, Shannon DC (1975) Adverse effect of positive end-expiratory pressure on pulmonary perfusion and arterial oxygenation. Am Rev Respir Dis 112:457–459PubMedGoogle Scholar
  21. 21.
    Marini JJ, Culver BH, Butler J (1981) Effect of positive end-expiratory pressure on canine ventricular function curves. J Appl Physiol 51:1367–1374PubMedGoogle Scholar
  22. 22.
    Potkin RT, Hudson LD, Weaver LJ, Trobaugh G (1987) Effect of positive end-expiratory pressure on right and left ventricular function in patients with the adult respiratory distress syndrome. Am Rev Respir Dis 135:307–311PubMedGoogle Scholar
  23. 23.
    Rothen HU, Sporre B, Engberg G, Wegenius G, Reber A, Hedenstierna G (1995) Prevention of atelectasis during general anaesthesia. Lancet 345:1387–1391PubMedGoogle Scholar
  24. 24.
    Neumann P, Rothen HU, Berglund JE, Valtysson J, Magnusson A, Hedenstierna G (1999) Positive end-expiratory pressure prevents atelectasis during general anaesthesia even in the presence of a high inspired oxygen concentration. Acta Anaesthesiol Scand 43:295–301CrossRefPubMedGoogle Scholar
  25. 25.
    Richard JC, Maggiore SM, Jonson B, Mancebo J, Lemaire F, Brochard L (2001) Influence of tidal volume on alveolar recruitment. Respective role of PEEP and a recruitment maneuver. Am J Respir Crit Care Med 163:1609–1613PubMedGoogle Scholar
  26. 26.
    Perchiazzi G, Högman M, Rylander C, Giuliani R, Fiore T, Hedenstierna G (2001) Assessment of respiratory system mechanics by artificial neural networks: an exploratory study. J Appl Physiol 90:1817–1824CrossRefPubMedGoogle Scholar
  27. 27.
    Murray JF, Matthay MA, Luce JM, Flick MR (1988) An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 138:720–723PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Department of Clinical PhysiologyUniversity HospitalLundSweden
  2. 2.Department of AnaesthesiaUniversity HospitalAngersFrance

Personalised recommendations