Journal of Applied Physiology, Vol 65, Issue 4 1488-1499, Copyright © 1988 by American Physiological Society

ARTICLES

Impact of PEEP on lung mechanics and work of breathing in severe airflow obstruction

T. C. Smith and J. J. Marini
Division of Pulmonary Medicine, Vanderbilt School of Medicine, Nashville, Tennessee 37232.

Positive end-expiratory pressure (PEEP) has generally been withheld from the treatment of patients with chronic airflow obstruction (CAO), in view of the risk of hyperinflation and lack of documented benefit. We studied 10 mechanically ventilated patients with exacerbated CAO and air trapping to determine the impact of PEEP on lung mechanics, alveolar pressure, and the work of breathing. PEEP levels of 5 and 10 cmH2O were applied to patients whose end-expiratory alveolar pressures were documented to be positive when breathing against ambient pressure (the auto-PEEP effect). All patients were studied under two conditions: every breath machine assisted (AMV) and every breath machine controlled (paralyzed, CMV). PEEP improved expiratory resistance without substantially increasing peak static pressure. Inspiratory resistance remained unchanged. The difference between the end-expiratory values of alveolar and central airway pressure narrowed as PEEP increased. Adding PEEP improved the effective triggering sensitivity of the ventilator, diminished ventilatory drive, and reduced the mechanical work of breathing during the machine-assisted ventilatory cycle. Our results indicate that low levels of PEEP may improve lung mechanics and reduce the effort required of mechanically ventilated patients with severe airflow obstruction, without substantially increasing the hazards of hyperinflation.

This article has been cited by other articles:

				N. MacIntyre and Y. C. Huang Acute Exacerbations and Respiratory Failure in Chronic Obstructive Pulmonary Disease Proceedings of the ATS, May 1, 2008; 5(4): 530 - 535. [Abstract] [Full Text] [PDF]

				S. Parthasarathy, A. Jubran, F. Laghi, and M. J. Tobin Sternomastoid, rib cage, and expiratory muscle activity during weaning failure J Appl Physiol, July 1, 2007; 103(1): 140 - 147. [Abstract] [Full Text] [PDF]

				A. E. Holland, L. Denehy, and J. W. Wilson Does expiratory flow limitation predict chronic dyspnoea in adults with cystic fibrosis? Eur. Respir. J., July 1, 2006; 28(1): 96 - 101. [Abstract] [Full Text] [PDF]

				M. Tzoufi, S. D. Mentzelopoulos, C. Roussos, and A. Armaganidis The Effects of Nebulized Salbutamol, External Positive End-Expiratory Pressure, and Their Combination on Respiratory Mechanics, Hemodynamics, and Gas Exchange in Mechanically Ventilated Chronic Obstructive Pulmonary Disease Patients Anesth. Analg., September 1, 2005; 101(3): 843 - 850. [Abstract] [Full Text] [PDF]

				V. Alvisi, A. Romanello, M. Badet, S. Gaillard, F. Philit, and C. Guerin Time Course of Expiratory Flow Limitation in COPD Patients During Acute Respiratory Failure Requiring Mechanical Ventilation Chest, May 1, 2003; 123(5): 1625 - 1632. [Abstract] [Full Text] [PDF]

				R. M. Kacmarek Ventilatory Muscle Function Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2002; 6(3): 189 - 201. [Abstract] [PDF]

				ATS/ERS Statement on Respiratory Muscle Testing Am. J. Respir. Crit. Care Med., August 15, 2002; 166(4): 518 - 624. [Full Text] [PDF]

				F J O'Donoghue, P G Catcheside, A S Jordan, A D Bersten, and R D McEvoy Effect of CPAP on intrinsic PEEP, inspiratory effort, and lung volume in severe stable COPD Thorax, June 1, 2002; 57(6): 533 - 539. [Abstract] [Full Text] [PDF]

				M Gorini, G Villella, R Ginanni, A Augustynen, D Tozzi, and A Corrado Effect of assist negative pressure ventilation by microprocessor based iron lung on breathing effort Thorax, March 1, 2002; 57(3): 258 - 262. [Abstract] [Full Text] [PDF]

				L. L. Szegedi, L. Barvais, Y. Sokolow, J. C. Yernault, and A. A. d'Hollander Intrinsic positive end-expiratory pressure during one-lung ventilation of patients with pulmonary hyperinflation. Influence of low respiratory rate with unchanged minute volume{dagger} Br. J. Anaesth., January 1, 2002; 88(1): 56 - 60. [Abstract] [Full Text] [PDF]

				N. R. MacIntyre Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support : A Collective Task Force Facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine Chest, December 1, 2001; 120(6_suppl): 375S - 396S. [Abstract] [Full Text] [PDF]

				H. A. Werner Status Asthmaticus in Children : A Review Chest, June 1, 2001; 119(6): 1913 - 1929. [Abstract] [Full Text] [PDF]

				M. GORINI, A. CORRADO, G. VILLELLA, R. GINANNI, A. AUGUSTYNEN, and D. TOZZI Physiologic Effects of Negative Pressure Ventilation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., June 1, 2001; 163(7): 1614 - 1618. [Abstract] [Full Text] [PDF]

				V. NINANE, D. LEDUC, S. A. KAFI, M. NASSER, M. HOUA, and R. SERGYSELS Detection of Expiratory Flow Limitation by Manual Compression of the Abdominal Wall Am. J. Respir. Crit. Care Med., May 1, 2001; 163(6): 1326 - 1330. [Abstract] [Full Text]

				M.P. Highcock, J.M. Shneerson, and I.E. Smith Functional differences in bi-level pressure preset ventilators Eur. Respir. J., February 1, 2001; 17(2): 268 - 273. [Abstract] [Full Text] [PDF]

				A. M Cross Review of the role of non-invasive ventilation in the emergency department Emerg. Med. J., March 1, 2000; 17(2): 79 - 85. [Full Text]

				T. F. Schuessler, S. B. Gottfried, and J. H. T. Bates A model of the spontaneously breathing patient: applications to intrinsic PEEP and work of breathing J Appl Physiol, May 1, 1997; 82(5): 1694 - 1703. [Abstract] [Full Text] [PDF]

				M. W. Elliott Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease N. Engl. J. Med., September 28, 1995; 333(13): 870 - 871. [Full Text]

				M. J. Tobin Mechanical Ventilation N. Engl. J. Med., April 14, 1994; 330(15): 1056 - 1061. [Full Text]