Journal of Applied Physiology, Vol 73, Issue 5 1728-1735, Copyright © 1992 by American Physiological Society

ARTICLES

Effect of PEEP on the mechanics of the respiratory system in ARDS patients

N. T. Eissa, V. M. Ranieri, C. Corbeil, M. Chasse, J. Braidy and J. Milic-Emili
Respiratory Division, Hopital Saint-Luc, Universite de Montreal, Quebec, Canada.

In patients with adult respiratory distress syndrome (ARDS) we studied the effect of positive end-expiratory pressure (PEEP) on respiratory mechanics. We used the technique of rapid airway occlusion during constant flow (V) inflation to partition the total respiratory system resistance (Rrs) into the interrupter resistance (Rint,rs) and the additional resistance (delta Rrs) due to viscoelastic pressure dissipations and time constant inequalities. We also measured static (Est,rs) and dynamic (Edyn,rs) elastance of the respiratory system. The procedure was carried out in nine ARDS patients at different inspiratory V and inflation volumes (delta V) at PEEP of 0, 5, 10, and 15 cmH2O. We found that during baseline ventilation (delta V = 0.7 liter and V = 1 l/s), Est,rs, Edyn,rs, and Rint,rs did not change significantly with PEEP, whereas delta Rrs and Rrs increased significantly only with PEEP of 15 cmH2O. The increase of delta Rrs and Rrs with PEEP was positively correlated with the concomitant changes in end-expiratory lung volume (P < 0.001). At all levels of PEEP, under iso-delta V conditions, delta Rrs decreased with increasing V, whereas at a fixed V, delta Rrs increased with increasing delta V. A four-parameter model of the respiratory system failed to fully describe respiratory dynamics in the ARDS patients, probably due to nonlinearities.

This article has been cited by other articles:

				A. G. Kaditis, E. K. Motoyama, W. Zin, N. Maekawa, I. Nishio, T. Imai, and J. Milic-Emili The Effect of Lung Expansion and Positive End-Expiratory Pressure on Respiratory Mechanics in Anesthetized Children Anesth. Analg., March 1, 2008; 106(3): 775 - 785. [Abstract] [Full Text] [PDF]

				E. Kondili, G. Prinianakis, H. Athanasakis, and D. Georgopoulos Lung emptying in patients with acute respiratory distress syndrome: effects of positive end-expiratory pressure Eur. Respir. J., May 1, 2002; 19(5): 811 - 819. [Abstract] [Full Text] [PDF]

				A. Vieillard-Baron, S. Prin, J.-M. Schmitt, R. Augarde, B. Page, A. Beauchet, and F. Jardin Pressure-Volume Curves in Acute Respiratory Distress Syndrome . Clinical Demonstration of the Influence of Expiratory Flow Limitation on the Initial Slope Am. J. Respir. Crit. Care Med., April 15, 2002; 165(8): 1107 - 1112. [Abstract] [Full Text] [PDF]

				P. R. M. ROCCO, E. M. NEGRI, P. M. KURTZ, F. P. VASCONCELLOS, G. H. SILVA, V. L. CAPELOZZI, P. V. ROMERO, and W. A. ZIN Lung Tissue Mechanics and Extracellular Matrix Remodeling in Acute Lung Injury Am. J. Respir. Crit. Care Med., September 15, 2001; 164(6): 1067 - 1071. [Abstract] [Full Text] [PDF]

				A. KOUTSOUKOU, A. ARMAGANIDIS, C. STAVRAKAKI-KALLERGI, T. VASSILAKOPOULOS, A. LYMBERIS, C. ROUSSOS, and J. MILIC-EMILI Expiratory Flow Limitation and Intrinsic Positive End-Expiratory Pressure at Zero Positive End-Expiratory Pressure in Patients with Adult Respiratory Distress Syndrome Am. J. Respir. Crit. Care Med., May 1, 2000; 161(5): 1590 - 1596. [Abstract] [Full Text]

				A. G. KADITIS, S. T. VENKATARAMAN, W. A. ZIN, and E. K. MOTOYAMA Partitioning of Respiratory System Resistance in Children with Respiratory Insufficiency Am. J. Respir. Crit. Care Med., February 1, 1999; 159(2): 389 - 396. [Abstract] [Full Text]

				L. GATTINONI, P. PELOSI, P. M. SUTER, A. PEDOTO, P. VERCESI, and A. LISSONI Acute Respiratory Distress Syndrome Caused by Pulmonary and Extrapulmonary Disease . Different Syndromes? Am. J. Respir. Crit. Care Med., July 1, 1998; 158(1): 3 - 11. [Abstract] [Full Text] [PDF]

				F. PETAK, M. J. HAYDEN, Z. HANTOS, and P. D. SLY Volume Dependence of Respiratory Impedance in Infants Am. J. Respir. Crit. Care Med., October 1, 1997; 156(4): 1172 - 1177. [Abstract] [Full Text] [PDF]