Update 1987 pp 192-198 | Cite as

Dynamic Hyperinflation: Intrinsic PEEP and Its Ramifications in Patients with Respiratory Failure

  • J. Milic-Emili
  • S. B. Gottfried
  • A. Rossi
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 3)


Pulmonary hyperinflation, which is defined as a consistent increase in the end-expiratory lung volume above the predicted functional residual capacity (FRC), is a characteristic abnormality in patients with acute or chronic airways obstruction [1]. While this may be the result of increased lung compliance (e.g. pulmonary emphysema), dynamic factors may also be responsible. For example, when there is a significant increase in airway resistance, the rate of lung emptying is unduly slowed and, by necessity, is interrupted by the next inspiratory effort. When the breathing frequency increases, as with exercise or increased ventilatory demands for other reasons, the expiratory time shortens and hence the end-expiratory lung volume may increase above the relaxed FRC position (elastic equilibrium volume), i.e. hyperinflation ensues. This process is referred to as dynamic hyperinflation. Expiratory flow may also be retarded by other mechanisms which contribute to the development of dynamic hyperinflation. These include activity of the inspiratory muscles during expiration (post-inspiration inspiratory activity) as well as activation of laryngeal adductor muscles with expiratory narrowing of the glottic aperture [10, 21, 24, 25].


Chronic Obstructive Pulmonary Disease Acute Respiratory Failure Functional Residual Capacity Inspiratory Muscle Maximum Inspiratory Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Bates DV, Macklem PT, Christie RV (eds) (1971) Respiratory function in disease. WB Saunders Company, Philadelphia PAGoogle Scholar
  2. 2.
    Behrakis PK, Higgs BD, Baydur A, Zin WA, Milic-Emili J (1983) Respiratory mechanics during halothane anesthesia and anesthesia-paralysis in man. J Appl Physiol 55:1085–1092PubMedGoogle Scholar
  3. 3.
    Bellemare F, Grassino A (1983) Force reserve of the diaphragm in patients with chronic obstructive pulmonary disease. J Appl Physiol 55:8–15PubMedGoogle Scholar
  4. 4.
    Bergman NA (1972) Intrapulmonary gas trapping during mechanical ventilation at rapid frequencies. Anesthesiology 37:626–633PubMedCrossRefGoogle Scholar
  5. 5.
    Bone RC (1976) Diagnosis of causes for acute respiratory distress by pressure-volume curves. Chest 70:740–746PubMedCrossRefGoogle Scholar
  6. 6.
    Buchler B, Magder S, Katsardis H, Jammes Y, Roussos C (1985) Effects of pleural pressure and abdominal pressure on diaphragmatic blood flow. J Appl Physiol 58:691–697PubMedGoogle Scholar
  7. 7.
    Campbell EJM, Dickinson CJ, Dinnick OP, Howell JBL (1961) The immediate effects of threshold loads on the breathing of men and dogs. Clin Sci 21:309–320PubMedGoogle Scholar
  8. 8.
    Chapin JC, Downs JB, Douglas ME, Murphy EJ, Ruiz BC (1979) Lung expansion, airway pressure transmission, and positive end-expiratory pressure. Arch Surg 114:1193–1197PubMedCrossRefGoogle Scholar
  9. 9.
    Colgan FJ, Barrow RE, Fanning GL (1971) Constant positive-pressure breathing and cardiorespiratory function. Anesthesiology 34:145–151PubMedCrossRefGoogle Scholar
  10. 10.
    Collett PW, Brancatisano T, Engel LA (1983) Changes in the glottic aperture during bronchial asthma. Am Rev Respir Dis 128:719–723PubMedGoogle Scholar
  11. 11.
    Feeley TW, Hedley-White J (1975) Weaning from controlled ventilation and supplemental oxygen. N Engl J Med 292:903–906PubMedCrossRefGoogle Scholar
  12. 12.
    Field S, Kelly SM, Macklem PT (1982) The oxygen cost of breathing in patients with cardiorespiratory failure. Am Rev Respir Dis 126:9–13PubMedGoogle Scholar
  13. 13.
    Fleury B, Murciano D, Talamo C, Aubier M, Pariente R, Milic-Emili J (1985) Work of breathing in patients with chronic obstructive pulmonary disease in acute respiratory failure. Am Rev Respir Dis 131:822–827PubMedGoogle Scholar
  14. 14.
    Gottfried SB, Rossi A, Higgs BD, et al (1985) Non-invasive determination of respiratory system mechanics during mechanical ventilation for acute respiratory failure. Am Rev Respir Dis 131:414–420PubMedGoogle Scholar
  15. 15.
    Kelly SM, Rosa A, Field S, Coughlin M, Shizgal HM, Macklem PT (1984) Inspiratory muscle strength and body composition in patients receiving total parenteral nutrition therapy. Am Rev Respir Dis 130:33–37PubMedGoogle Scholar
  16. 16.
    Kimball WR, Leith DE, Robins AG (1982) Dynamic hyperinflation and ventilator dependence in chronic obstructive pulmonary disease. Am Rev Respir Dis 126:991–995PubMedGoogle Scholar
  17. 17.
    Lavietes MH, Rochester DF (1981) Assessment of airway function during assisted ventilation. Lung 159:219–229PubMedCrossRefGoogle Scholar
  18. 18.
    LeSouef PN, England SJ, Bryan AC (1984) Passive respiratory mechanics in newborns and children. Am Rev Respir Dis 129:552–556PubMedGoogle Scholar
  19. 19.
    Macklem PT. Hyperinflation (1984) Am Rev Respir Dis 129:1–2PubMedGoogle Scholar
  20. 20.
    Marini JJ, Capps JS, Culver BH (1985) The inspiratory work of breathing during assisted mechanical ventilation. Chest 87:612–18PubMedCrossRefGoogle Scholar
  21. 21.
    Martin J, Powell E, Shore S, Emrich J, Engel LA (1980) The role of the respiratory muscles in the hyperinflation of bronchial asthma. Am Rev Respir Dis 123:441–447Google Scholar
  22. 22.
    Martin JG, Shore S, Engel LA (1982) Effect of continuous positive airway pressure on respiratory mechanics and pattern of breathing in induced asthma. Am Rev Respir Dis 126:812–817PubMedGoogle Scholar
  23. 23.
    Mead J (1979) Responses to loaded breathing. Bull Eur Physiopath Respir 15:61–71(Suppl)Google Scholar
  24. 24.
    Mortola JP, Milic-Emili J, Noworaj A, Smith B, Fox G, Weeks S (1984) Muscle pressure and flow during expiration in infants. Am Rev Respir Dis 129:49–53PubMedGoogle Scholar
  25. 25.
    Muller N, Bryan AC, Zamel N (1980) Tonic inspiratory muscle activity as a cause of hyperinflation in histamine-induced asthma. J Appl Physiol 49:869–874PubMedGoogle Scholar
  26. 26.
    Murciano D, Aubier M, Bussi S, Derenne J-Ph, Pariente R, Milic-Emili J (1982) Comparison of esophageal, tracheal, and mouth occlusion pressure in patients with chronic obstructive pulmonary disease during acute respiratory failure. Am Rev Respir Dis 126:837–841PubMedGoogle Scholar
  27. 27.
    Pepe PE, Marini JJ (1982) Occult positive end-expiratory pressure in mechanically ventilated patients with airflow obstruction. Am Rev Respir Dis 126:166–170PubMedGoogle Scholar
  28. 28.
    Rochester DJ, Arora NS (1983) Respiratory muscle failure. Med Clin N Amer 67:573–597PubMedGoogle Scholar
  29. 29.
    Rossi A, Gottfried SB, Zocchi L, et al (1985) Measurement of static compliance of the total respiratory system in patients with acute respiratory failure during mechanical ventilation: the effect of intrinsic positive end-expiratory pressure. Am Rev Respir Dis 131:672–677PubMedGoogle Scholar
  30. 30.
    Saetta M, Rossi A, Gottfried SB, et al (1985) Expiratory volume-flow relationship during mechanical ventilation in patients with acute respiratory failure. Am Rev Respir Dis 131:A132Google Scholar
  31. 31.
    Sahn SA, Lakshminarayan S (1973) Bedside criteria for discontinuation of mechanical ventilation. Chest 63:1002–1005PubMedCrossRefGoogle Scholar
  32. 32.
    Sharp JT, van Lith P, Nuchprayoon CV, Briney R, Johnson FN (1968) The thorax in chronic obstructive lung disease. Am J Med 44:39–46CrossRefGoogle Scholar
  33. 33.
    Suter PM, Fairley HB, Isenberg MD (1975) Optimum end-expiratory airway pressure in patients with acute pulmonary failure. N Engl J Med 292:284–289PubMedCrossRefGoogle Scholar
  34. 34.
    Sybrecht GW, Taubner EM, Bohm MM, Fabel H (1979) Mechanical properties of the respiratory system and mouth-occlusion pressure in patients acutely intoxicated with hypnotics. Lung 156:49–56PubMedCrossRefGoogle Scholar
  35. 35.
    Vinegar, Sinnett EE, Leith DE (1979) Dynamic mechanisms determine functional residual capacity in mice, Mus musculus. J Appl Physiol 46:867–871Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1987

Authors and Affiliations

  • J. Milic-Emili
  • S. B. Gottfried
  • A. Rossi

There are no affiliations available

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