Dead space analysis at different levels of positive end-expiratory pressure in acute respiratory distress syndrome patients

Purpose: To analyze the effects of positive end-expiratory pressure (PEEP) on Bohr's dead space (VDBohr/VT) in patients with acute respiratory distress syndrome (ARDS).Material and methods: Fourteen ARDS patients under lung protective ventilation settingswere submitted to 4 different levels of PEEP (0, 6, 10, 16 cmH(2)O). Respiratory mechanics, hemodynamics and volumetric capnography were recorded at each protocol step.Results: Two groups of patients responded differently to PEEP when comparing baseline with 16-PEEP: those in which driving pressure increased > 15% (Delta P.(15%), n = 7, p = .016) and those in which the change was <= 15% (Delta P-<= 15%, n = 7, p = .700). VDBohr/VT was higher in Delta P-<= 15% than in Delta P-<= 15% patients at baseline ventilation [0.58 (0.49-0.60) vs 0.46 (0.43-0.46) p = .018], at 0-PEEP [0.50 (0.47-0.54) vs 0.41 (0.40-0.43) p = .012], at 6-PEEP [0.55 (0.49-0.57) vs 0.44 (0.42-0.45) p = .008], at 10-PEEP [0.59 (0.51-0.59) vs 0.45 (0.44-0.46) p = .006] and at 16-PEEP [0.61 (0.56-0.65) vs 0.47 (0.45-0.48) p =. 001]. We found a good correlation between Delta P and VDBohr/VT only in the Delta P.(15%) group (r = 0.74, p < .001).Conclusions: Increases in PEEP result in higher VDBohr/VT only when associated with an increase in driving pressure.

Ducrey, MarcelaHosp Italiano Buenos Aires, Dept Intens Care Med, Buenos Aires, DF, Argentina (författare)
Dianti, JoseHosp Italiano Buenos Aires, Dept Intens Care Med, Buenos Aires, DF, Argentina (författare)
Madorno, MatiasInst Tecnol Buenos Aires ITBA, Buenos Aires, DF, Argentina (författare)
Roux, NicolasHosp Italiano Buenos Aires, Dept Intens Care Med, Buenos Aires, DF, Argentina (författare)
Midley, AlejandroHosp Italiano Buenos Aires, Dept Intens Care Med, Buenos Aires, DF, Argentina (författare)
Raffo, JulioHosp Italiano Buenos Aires, Dept Intens Care Med, Buenos Aires, DF, Argentina (författare)
Giannasi, SergioHosp Italiano Buenos Aires, Dept Intens Care Med, Buenos Aires, DF, Argentina (författare)
San Roman, EduardoHosp Italiano Buenos Aires, Dept Intens Care Med, Buenos Aires, DF, Argentina (författare)
Suarez-Sipmann, FernandoUppsala universitet,Anestesiologi och intensivvård,Hedenstiernalaboratoriet,CIBERES, Madrid, Spain;Hosp Univ & Politecn La Fe, Serv Med Intens, Valencia, Spain(Swepub:uu)fersi946 (författare)
Tusman, GerardoHosp Privado Comunidad Mar Del Plata, Dept Anesthesiol, Mar Del Plata, Buenos Aires, Argentina (författare)
Hosp Italiano Buenos Aires, Dept Intens Care Med, Buenos Aires, DF, ArgentinaInst Tecnol Buenos Aires ITBA, Buenos Aires, DF, Argentina (creator_code:org_t)

Ingår i:Journal of critical care: W B SAUNDERS CO-ELSEVIER INC45, s. 231-2380883-94411557-8615

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