Ventillatory stimulus suppression in intrinsic peep patients

1988 ◽  
Vol 14 (4) ◽  
pp. 443-444
Author(s):  
R. Fernández ◽  
S. Benito
Keyword(s):  
Intrinsic Peep ◽  
Stimulus Suppression

scholarly journals Maintenance of end-expiratory recruitment with increased respiratory rate after saline-lavage lung injury

2007 ◽  
Vol 102 (1) ◽  
pp. 331-339 ◽  
Author(s):  
Rebecca S. Syring ◽  
Cynthia M. Otto ◽  
Rebecca E. Spivack ◽  
Klaus Markstaller ◽  
James E. Baumgardner
Keyword(s):  
Cardiac Output ◽  
Lung Injury ◽  
Respiratory Rate ◽  
Pressure Control ◽  
Plateau Pressure ◽  
Control Mode ◽  
Intrinsic Peep ◽  
Mixed Venous Saturation ◽  
Mixed Venous ◽  
Saline Lavage

Cyclical recruitment of atelectasis with each breath is thought to contribute to ventilator-associated lung injury. Extrinsic positive end-expiratory pressure (PEEPe) can maintain alveolar recruitment at end exhalation, but PEEPe depresses cardiac output and increases overdistension. Short exhalation times can also maintain end-expiratory recruitment, but if the mechanism of this recruitment is generation of intrinsic PEEP (PEEPi), there would be little advantage compared with PEEPe. In seven New Zealand White rabbits, we compared recruitment from increased respiratory rate (RR) to recruitment from increased PEEPe after saline lavage. Rabbits were ventilated in pressure control mode with a fraction of inspired O2 (FiO2) of 1.0, inspiratory-to-expiratory ratio of 2:1, and plateau pressure of 28 cmH2O, and either 1) high RR ( 24 ) and low PEEPe (3.5) or 2) low RR ( 7 ) and high PEEPe ( 14 ). We assessed cyclical lung recruitment with a fast arterial Po2 probe, and we assessed average recruitment with blood gas data. We measured PEEPi, cardiac output, and mixed venous saturation at each ventilator setting. Recruitment achieved by increased RR and short exhalation time was nearly equivalent to recruitment achieved by increased PEEPe. The short exhalation time at increased RR, however, did not generate PEEPi. Cardiac output was increased on average 13% in the high RR group compared with the high PEEPe group ( P < 0.001), and mixed venous saturation was consistently greater in the high RR group ( P < 0.001). Prevention of end-expiratory derecruitment without increased end-expiratory pressure suggests that another mechanism, distinct from intrinsic PEEP, plays a role in the dynamic behavior of atelectasis.

scholarly journals P67 Laryngeal Narrowing In Chronic Obstructive Pulmonary Disease (copd): A Mechanism For Generating Intrinsic Peep?

Thorax ◽  
2014 ◽  
Vol 69 (Suppl 2) ◽  
pp. A104-A104
Author(s):  
M. Baz ◽  
G. Haji ◽  
A. Menzies-Gow ◽  
R. Tanner ◽  
N. Hopkinson ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Intrinsic Peep ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

scholarly journals Effect of nocturnal EPAP titration to abolish tidal expiratory flow limitation in COPD patients with chronic hypercapnia: a randomized, cross-over pilot study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Emanuela Zannin ◽  
Ilaria Milesi ◽  
Roberto Porta ◽  
Simona Cacciatore ◽  
Luca Barbano ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Work Of Breathing ◽  
Lung Mechanics ◽  
Intrinsic Peep ◽  
Chronic Obstructive ◽  
Flow Limitation ◽  
Expiratory Flow Limitation ◽  
Copd Patients ◽  
Ineffective Efforts ◽  
Expiratory Flow

Abstract Background Tidal expiratory flow limitation (EFLT) promotes intrinsic PEEP (PEEPi) in patients with chronic obstructive pulmonary disease (COPD). Applying non-invasive ventilation (NIV) with an expiratory positive airway pressure (EPAP) matching PEEPi improves gas exchange, reduces work of breathing and ineffective efforts. We aimed to evaluate the effects of a novel NIV mode that continuously adjusts EPAP to the minimum level that abolishes EFLT. Methods This prospective, cross-over, open-label study randomized patients to one night of fixed-EPAP and one night of EFLT-abolishing-EPAP. The primary outcome was transcutaneous carbon dioxide pressure (PtcCO2). Secondary outcomes were: peripheral oxygen saturation (SpO2), frequency of ineffective efforts, breathing patterns and oscillatory mechanics. Results We screened 36 patients and included 12 in the analysis (age 72 ± 8 years, FEV1 38 ± 14%Pred). The median EPAP did not differ between the EFLT-abolishing-EPAP and the fixed-EPAP night (median (IQR) = 7.0 (6.0, 8.8) cmH2O during night vs 7.5 (6.5, 10.5) cmH2O, p = 0.365). We found no differences in mean PtcCO2 (44.9 (41.6, 57.2) mmHg vs 54.5 (51.1, 59.0), p = 0.365), the percentage of night time with PtcCO2 > 45 mm Hg was lower (62(8,100)% vs 98(94,100)%, p = 0.031) and ineffective efforts were fewer (126(93,205) vs 261(205,351) events/hour, p = 0.003) during the EFLT-abolishing-EPAP than during the fixed-EPAP night. We found no differences in oxygen saturation and lung mechanics between nights. Conclusion An adaptive ventilation mode targeted to abolish EFLT has the potential to reduce hypercapnia and ineffective efforts in stable COPD patients receiving nocturnal NIV. Trial registration: ClicalTrials.gov, NCT04497090. Registered 29 July 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04497090.

1156: IMPROVING PATIENT VENTILATOR SYNCHRONY WITH MEASURING INTRINSIC PEEP TO SET VENTILATOR PEEP IN SBPD

2018 ◽  
Vol 46 (1) ◽  
pp. 562-562
Author(s):  
Natalie Napolitano ◽  
Khair Jalal ◽  
Joseph McDonough ◽  
Heather Bosenstab ◽  
Kevin Dysart ◽  
...  
Keyword(s):  
Intrinsic Peep ◽  
Ventilator Synchrony

Dynamic Hyperinflation and Intrinsic Positive End-Expiratory Pressure

2017 ◽  
Author(s):  
John W. Kreit
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Adverse Effects ◽  
Obstructive Lung Disease ◽  
Airflow Obstruction ◽  
Intrinsic Peep ◽  
Dynamic Hyperinflation ◽  
Positive End Expiratory Pressure ◽  
Inspiratory Time ◽  
Pulmonary Barotrauma

Dynamic hyperinflation and intrinsic PEEP almost always occur in patients with severe obstructive lung disease, in whom slowing of expiratory flow prevents complete exhalation. Occasionally, patients without airflow obstruction develop dynamic hyperinflation when expiratory time, is excessively shortened by a rapid respiratory rate, a long set inspiratory time (TI), or both. Dynamic Hyperinflation and Intrinsic Positive End-Expiratory Pressure describes the causes of dynamic hyperinflation and the mechanisms of its adverse effects, including reduced cardiac output and blood pressure, pulmonary barotrauma, and ineffective ventilator triggering. The chapter also describes how to screen for and measure intrinsic PEEP, and how to reduce or eliminate its adverse effects.

Intrinsic PEEP monitored in the ventilated ARDS patient with a mathematical method

1992 ◽  
Vol 73 (2) ◽  
pp. 479-485 ◽  
Author(s):  
L. Eberhard ◽  
J. Guttmann ◽  
G. Wolff ◽  
W. Bertschmann ◽  
A. Minzer ◽  
...  
Keyword(s):  
Mathematical Method ◽  
Distress Syndrome ◽  
Intensive Care Patient ◽  
Care Patient ◽  
Intrinsic Peep ◽  
Positive End Expiratory Pressure ◽  
Alveolar Pressure ◽  
Controlled Ventilation ◽  
Volume Controlled Ventilation ◽  
Volume Controlled

Under mechanical volume-controlled ventilation, the intensive care patient can develop intrinsic positive end-expiratory pressure (iPEEP); that is, the passive expiration is terminated by the following inspiration before the alveolar pressure comes to its physical equilibrium value. We present a mathematical method to estimate this alveolar dynamic iPEEP breath by breath, without the need of a maneuver. We tested it in paralyzed patients ventilated for adult respiratory distress syndrome after multiple trauma and/or sepsis, and we compared the results obtained with the new mathematical method with those from the occlusion method introduced by Pepe and Marini. The results agreed well (median difference of 0.8 mbar in 201 investigations in 12 patients). However, the mathematically determined values, representing dynamic iPEEP, are systematically slightly smaller than those measured by the occlusion maneuver. A variation of expiratory time suggests that this difference might be due to mechanical time-constant inhomogeneity, viscoelastic processes, or other mechanisms showing time dependence.

Identifying and treating intrinsic PEEP in infants with severe bronchopulmonary dysplasia

2019 ◽  
Vol 54 (7) ◽  
pp. 1045-1051 ◽  
Author(s):  
Natalie Napolitano ◽  
Khair Jalal ◽  
Joseph M. McDonough ◽  
Heather M. Monk ◽  
Huayan Zhang ◽  
...  
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Intrinsic Peep
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