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Static and Dynamic Intrinsic PEEP and Respiratory Mechanics in Mechanically Ventilated COPD Patients

  • V. Antonaglia
  • A. Peratoner
  • L. De Simoni
Conference paper

Abstract

In 1982, Pepe and Marini [1] pointed out the clinical importance of dynamic increase in end-expiratory lung volume and positive end-expiratory alveolar pressure in mechanically ventilated patients with airflow obstruction. This end-expiratory pressure was termed “occult, auto or intrinsic PEEP” (PEEPi) and is due to the positive end-expiratory elastic recoil pressure of the total respiratory system consequent to incomplete lung emptying. In patients with severe airflow obstruction, because the rate of the lung emptying is slow relative to the available expiratory duration, the expiration is interrupted by the subsequent breath before the relaxation volume of the respiratory system (Vr) is reached. The increase in end expiratory lung volume above Vr is termed dynamic pulmonary hyperinflation. Dynamic hyperinflation and PEEPi were detected not only in ventilated patients with airway obstruction but also in ventilated patients with other disorders [2–4] and in all ventilatory conditions in which a short expiratory time is used, as inverse ratio ventilation (5, 6].

Keywords

Chronic Obstructive Pulmonary Disease Continuous Positive Airway Pressure Acute Respiratory Failure Control Mechanical Ventilation Dynamic Hyperinflation 
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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References

  1. 1.
    Pepe PE, Marini JJ (1982) Occult positive end-expiratory pressure in mechanically ventilated patients with airflow obstruction: the auto-PEEP effect. Am Rev Respir Dis 126: 166–170PubMedGoogle Scholar
  2. 2.
    Gottfried SB, Rossi A, Milic-Emili J (1986) Dynamic hyperinflation, intrinsic PEEP, and the mechanically ventilated patient. Intensive and Critical Care Digest 5: 30–33Google Scholar
  3. 3.
    Broseghini C, Brandolese R, Poggi R et al (1988) Respiratory mechanics during the first day of mechanical ventilation in patients with pulmonary edema and chronic airway obstruction. Am Rev Respir Dis 138: 355–361PubMedGoogle Scholar
  4. 4.
    Broseghini C, Brandolese R, Poggi R et al (1988) Respiratory resistance and intrinsic positive end-expiratory pressure in patients with the adult respiratory distress syndrome Eur Respir J 1: 726–731Google Scholar
  5. 5.
    Abraham E, Yoshihara G (1989) Cardiorespiratory effects of pressure controlled inverse ratio ventilation in severe respiratory failure. Chest 96: 1356–1359PubMedCrossRefGoogle Scholar
  6. 6.
    Mercat A, Titiriga M, Anguel N et al (1997) Inverse ratio ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med 155: 1637–1642PubMedGoogle Scholar
  7. 7.
    Smith TC, Marini JJ (1988) Impact of PEEP on lung mechanics and work of breathing in severe airflow obstruction. J Appl Physiol 65: 1488–1499PubMedGoogle Scholar
  8. 8.
    Fernandez R, Benito S, Blanch LL (1988) Intrinsic PEEP: a cause of inspiratory muscle ineffectivity. Intensive Care Med 15: 51–52PubMedCrossRefGoogle Scholar
  9. 9.
    Braschi A, Iotti G, Rodi G et al (1988) Dynamic pulmonary hyperinflation during intermittent mandatory ventilation. Intensive Care Med 14: 284–287Google Scholar
  10. 10.
    Rossi A, Brandolese R, Milic-Emili J et al (1990) The role of PEEP in patients with chronic obstructive pulmonary disease during assisted ventilation. Eur Respir J 3: 818–822PubMedGoogle Scholar
  11. 11.
    Calderini E, Petrof B, Gottfried SB (1989) Continuous positive airway pressure improves efficacy of pressure support ventilation in severe COPD. Am Rev Respir Dis 139: A155Google Scholar
  12. 12.
    Petrof BJ, Legare M, Goldberg P et al (1990) Continuous positive airway pressure reduces work of breathing and dyspnea during weaning from mechanical ventilation in severe chronic obstructive pulmonary diseases. Am Rev Respir Dis 141: 281–289PubMedGoogle Scholar
  13. 13.
    Campbell FJM, Dikinson CJ, Dinnick OP, Howell JBL (1964) The immediate effects of threshold loads on the breathing of men and dogs. Clin Sci 172: 321–331Google Scholar
  14. 14.
    Fleury B, Murciano C, Talamo C et al (1985) Work of breathing in patients with chronic obtructive pulmonary disease in acute respiratory failure. Am Rev Respir Dis 131: 822–827PubMedGoogle Scholar
  15. 15.
    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
  16. 16.
    Brown DG,Pierson DJ (1986) Auto-PEEP is a common in mechanically ventilated patients: a study of incidence, severity, and detection. Respir Care 31: 1069–1074Google Scholar
  17. 17.
    Gottfried SB, Milic-Emili J (1986) Non-invasive monitoring of respiratory system mechanics. In: Cherniack NS, Nochomovitz M (eds) Non-invasive respiratory monitoring. Churchill Livingston, New York, pp 59–82Google Scholar
  18. 18.
    Benson MS, Pierson DJ (1988) Auto-PEEP during mechanical ventilation of adults. Respir Care 33: 557–565Google Scholar
  19. 19.
    Marini JJ (1988) Monitoring during mechanical ventilation. Clin Chest Med 9: 73–100PubMedGoogle Scholar
  20. 20.
    Patel H, Yang K (1995) Variability of intrinsic positive end-expiratory pressure in patients receiving mechanical ventilation. Crit Care Med 23: 1074–1079PubMedCrossRefGoogle Scholar
  21. 21.
    Gay CG, Rodarte JR, Hubmayr RD (1989) The effects of positive expiratory pressure on isovolume flow and dynamic hyperinflation in patients receiving mechanical ventilation. Am Rev Respir Dis 139: 621–626PubMedGoogle Scholar
  22. 22.
    Ranieri MV, Giuliani R, Cinella G et al (1993) Physiologic effects of positive end-expiratory pressure in patients with chronic obstructive pulmonary disease during acute ventilatory failure and controlled mechanical ventilation. Am Rev Respir Dis 147: 5–13PubMedCrossRefGoogle Scholar
  23. 23.
    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
  24. 24.
    Ninane V, Yernault JC, De Troyer A (1993) Intrinsic PEEP in patients with chronic obstructive pulmonary disease: role of expiratory muscles. Am Rev Respir Dis 148: 1037–1042PubMedCrossRefGoogle Scholar
  25. 25.
    Lessard MR, Lofaso F, Brochard L (1995) Expiratory muscle activity increases intrinsic positive end-expiratory pressure independently of dynamic hyperinflation in mechanically ventilated patients. Am J Respir Crit Care Med 151: 562–569PubMedGoogle Scholar
  26. 26.
    Yan S, Kayser B, Tobiasz M, Sliiwinski P (1996) Comparison of static and dynamic intrinsic positive end-expiratory pressure using the Campbell Diagram. Am J Respir Crit Care Med 154: 938–944PubMedGoogle Scholar
  27. 27.
    Hernandez P, Navalesi P, Maltais F et al (1994) Comparison of static and dynamic measurements of intrinsic PEEP in anesthetized cats. J Appl Physiol 76: 2437–2442PubMedGoogle Scholar
  28. 28.
    Maltais F, Reissmann H, Navalesi P et al (1994) Comparison of static and dynamic measurements of intrinsic PEEP in mechanically ventilated patients. Am J Respir Crit Care Med 150: 1318–1324PubMedGoogle Scholar
  29. 29.
    Gay PC, Rodarte JR, Hubmayr RD (1989) The effects of PEEP on isovolume flow and dynamic hyperinflation in patients receiving mechanical ventilation. Am Rev Resp Dis 139: 621–626PubMedGoogle Scholar
  30. 30.
    Ranieri VM, Giuliani R, Cinella G et al (1993) A physiologic effects of PEEP in patients with COPD during acute respiratory failure and controlled mechanical ventilation. Am Rev Resp Dis 147: 5–13PubMedCrossRefGoogle Scholar
  31. 31.
    Van Den Berg B, Aerts JGJV, Bogaard JM (1995) Effect of continuous positive airway pressure in patients with chronic obstructive pulmonary disease depending on intrinsic PEEP levels. Acta Anaesthesiol Scand 39: 1097–1102PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • V. Antonaglia
  • A. Peratoner
  • L. De Simoni

There are no affiliations available

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