Intermittent Positive Pressure Ventilation and PEEP
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Mechanical ventilatory support is a routine event in intensive care units for patients with compromised cardiopulmonary function. Despite numerous papiers on the effects of PEEP on the circulatory system, until recently little attention has been focused on the “control” state of IPPV [1–7]. A physiologic approach to understanding the effects of PEEP can be derived by considering PEEP as simply IPPV at an increased lung volume during both a single respiratory cycle and steady state conditions. Unfortunately the physiologic variables which are affected by increased lung volume and pleural pressure may have diametrically opposing effects such that straight forward predictions may not be possible. The baseline conditions under which the ventilatory support is instituted may profoundly influence which factors will dominate. Even a question as simple as what effect an increase in pleural pressure will have on cardiac output is dependent on baseline conditions.
KeywordsAortic Flow Pleural Pressure Intermittent Positive Pressure Ventilation Systemic Venous Return Increase Lung Volume
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