- Oral presentation
- Open Access
Effects of Positive End Expiratory Pressure On Regional Ventilation-Perfusion Matching And Respiratory Mechanics: A Clinical Study
© Eronia et al.; 2015
- Published: 1 October 2015
- Electrical Impedance Tomography
- Lung Region
- Peep Level
- Regional Compliance
- Control Mechanical Ventilation
In intubated acute respiratory failure patients, inhomogeneity of ventilation-perfusion matching (i.e., presence of over-ventilated under-perfused lung regions) might determine extreme pH shifts and increase the risk of developing ventilator-induced injury. Positive end-expiratory pressure (PEEP) redistributes tidal ventilation towards more perfused dependent lung regions, potentially improving homogeneity of ventilation-perfusion matching.
In this study, we used Electrical Impedance Tomography (EIT) to assess global and regional lung ventilation and perfusion at different PEEP levels and to verify the effects of PEEP on homogeneity of ventilation-perfusion matching.
We enrolled 20 intubated critically ill patients undergoing controlled mechanical ventilation, sedated, paralyzed, with PaO2/FiO2≤300 mmHg and PEEP≥5 cmH2O. We randomly applied two PEEP levels (clinical and clinical + 5 cmH2O) for 20 minutes each and collected ventilation and EIT data at the end of each step. From EIT, we measured: 1. regional ventilation heterogeneity (VtHet, defined as the ratio between Vt reaching non-dependent/dependent lung); 2. regional homogeneity of ventilation-perfusion matching (HV/P); 3. regional compliance; 4. cumulated regional lung hyperdistension.
Finally, by applying higher PEEP, regional compliance of non-dependent lung decreased (31 ± 12 vs. 37 ± 13 mL/cmH2O, p < 0.001) and cumulative hyperdistension of the same areas significantly increased (+18 ± 7%, p < 0.001).
Improved homogeneity of ventilation-perfusion matching might represent one of the protective mechanisms associated with the use of higher PEEP. On the other hand, such benefits must be balanced with increased risk of hyperdistension of non-dependent lung.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.