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The interaction between applied PEEP and auto-PEEP during one-lung ventilation.

Abstract：

OBJECTIVE:To investigate the relationship between applied external positive end-expiratory pressure (PEEP) and auto-PEEP and the resultant total PEEP experienced by the patient during one-lung ventilation (OLV). DESIGN:A prospective clinical study. SETTING:A university hospital. PARTICIPANTS:Ten adult patients undergoing elective thoracotomies. INTERVENTIONS:End-expiratory airway occlusion and measurement of plateau pressure during two-lung ventilation (TLV) and OLV with and without the application of 5 cm H2O of external PEEP via the anesthetic ventilator. The effect of variation of the inspiratory-expiratory ratio on total PEEP with and without applied external PEEP was also studied. MAIN RESULTS:The mean level (+/-SD) of auto-PEEP changing from two-lung to one-lung ventilation rose from 0.9 (+/-0.8) cm H2O to 6.0 (+/-3.0) cm H2O at an inspiratory-expiratory ratio of 1:2. The application of 5 cm H2O external PEEP did not increase the total PEEP (7.3+/-2.0 cm H2O) significantly. The total PEEP increased significantly when the duration of expiration was decreased, and decreased when expiratory time increased. The change in total PEEP caused by the application of external PEEP during OLV correlated inversely with the preexisting level of auto-PEEP (r=-0.84). CONCLUSION:The change in end-expiratory pressure experienced by the ventilated lung during OLV when external PEEP is applied depends on the preexisting level of auto-PEER This may explain some of the inconsistencies in the clinical results of application of external PEEP during OLV. The total PEEP delivered to the patient should be measured whenever external PEEP is applied during OLV.

journal_name

J Cardiothorac Vasc Anesth

journal_title

Journal of cardiothoracic and vascular anesthesia

authors

Slinger PD,Hickey DR

doi

10.1016/s1053-0770(98)90318-4

subject

Has Abstract

pub_date

1998-04-01 00:00:00

pages

133-6

issue

2

eissn

1053-0770

issn

1532-8422

pii

S1053-0770(98)90318-4

journal_volume

12

pub_type

杂志文章

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