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Intensive Care Medicine

, Volume 31, Issue 10, pp 1370–1378 | Cite as

Inspiratory vs. expiratory pressure-volume curves to set end-expiratory pressure in acute lung injury

  • Guillermo M. AlbaicetaEmail author
  • Luis H. Luyando
  • Diego Parra
  • Rafael Menendez
  • Juan Calvo
  • Paula Rodríguez Pedreira
  • Francisco Taboada
Original

Abstract

Objective

To study the effects of two levels of positive end-expiratory pressure (PEEP), 2 cmH2O above the lower inflection point of the inspiratory limb and equal to the point of maximum curvature on the expiratory limb of the pressure-volume curve, in gas exchange, respiratory mechanics, and lung aeration.

Design and setting

Prospective clinical study in the intensive care unit and computed tomography ward of a university hospital.

Patients

Eight patients with early acute lung injury.

Interventions

Both limbs of the static pressure-volume curve were traced and inflection points calculated using a sigmoid model. During ventilation with a tidal volume of 6 ml/kg we sequentially applied a PEEP 2 cmH2O above the inspiratory lower inflection point (15.5±3.1 cmH2O) and a PEEP equal to the expiratory point of maximum curvature (23.5±4.1 cmH2O).

Measurements and results

Arterial blood gases, respiratory system compliance and resistance and changes in lung aeration (measured on three computed tomography slices during end-expiratory and end-inspiratory pauses) were measured at each PEEP level. PEEP according to the expiratory point of maximum curvature was related to an improvement in oxygenation, increase in normally aerated, decrease in nonaerated lung volumes, and greater alveolar stability. There was also an increase in PaCO2, airway pressures, and hyperaerated lung volume.

Conclusions

High PEEP levels according to the point of maximum curvature of the deflation limb of the pressure-volume curve have both benefits and drawbacks.

Keywords

Acute lung injury Positive end-expiratory pressure Pressure-volume curves Computed tomography Mechanical ventilation 

Notes

Acknowledgements

The authors thank all the nursing and technician personnel in the Intensive Care Unit and CT Ward of the Hospital Universitario Central de Asturias for their help. We also thank Ana Villagrá for her suggestions about the manuscript.

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Guillermo M. Albaiceta
    • 1
    Email author
  • Luis H. Luyando
    • 2
  • Diego Parra
    • 1
  • Rafael Menendez
    • 2
  • Juan Calvo
    • 2
  • Paula Rodríguez Pedreira
    • 1
  • Francisco Taboada
    • 1
  1. 1.Department of Intensive MedicineHospital Universitario Central de AsturiasOviedoSpain
  2. 2.Department of RadiologyHospital Universitario Central de AsturiasOviedoSpain

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