| Relationship of compliance and oxygen transport in experimental acute respiratory failure during positive end-expiratory pressure ventilation. |
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Sang Do Lee1, Se Jin Yoon1, Bok Hee Lee1, Sung Koo Han2, Young-Soo Shim2, Keun Youl Kim2, Yong Chol Han2 |
1Department of Internal Medicine, Chungbuk National University, College of Medicine, Cheongju, Korea
2Department of Internal Medicine, Seoul National University, College of Medicine, Seoul, Korea |
| 실험적 급성호흡부전에서 호기말양압에 의한 폐유순도와 산소운반의 변화및 상관관계
-호흡부전의 기전에 따른 차이 - |
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| Abstract |
Background
Positive end-expiratory pressure (PEEP) has become one of the standard therapies for adult respiratory distress syndrome (ARDS). Total static compliance has been proposed as a guide to determine the size of PEEP (‘best PEEP’) which is of unproven clinical benefit and remains controversia l. Besides increasing functional residual capacity and thus improving oxygenation, PEEP stimulate prostacyclin secretion and was proposed for the treatment of acute pulmonary embolism.
But little is known about the effect of PEEP on hemodynamic and gas exchange disturbances in acute pulmonary embolism.
Methods
To study the validity of total static compliance as a predictor of ‘best PEEP’ inARDS and acute pulmonary embolism, experimental ARDS was induced in mongrel dog with oleic acid and acute pulmonary embolism with autologous blood clot. Then hemodynamic and gas exchange parameters were measured with serial increment of PEEP
Results
ln ARDS group, total static compliance and oxygen transport were maximal at 5 cmH2O, and decreased thereafter (p<0.05). With increment of PEEP, arterial oxygen tension (PaO2) and arterial carbon dioxide tension (PaCO2) increased and cardiac output and physiological shunt decreased. In pulmonary embolism group, total static compliance, oxygen transport , physiological shunt and cardiac output decreased and PaO2, and PaCO2, increased with increment of PEEP (p < 0.05). Comparing the change induced by increment of PEEP by 1 cmH20 in ARDS group with that in pulmonary embolism group, there was no significant difference between two groups except cardiac output which decreased more in pulmonary embolism group (p<0.05) . In ARDS group, oxygen transport and total static compliance increased after PEEP application, and total static compliance was maximal at the PEEP level where oxygen transport was maximal. However in pulmonary embolism group, oxygen transport and total static compliance decreased after application of PEEP. There was significant correlation between change of total static compliance and change of oxygen transport in both groups.
Conclusion
In both ARDS and acute pulmonary embolism, it can be concluded that total static compliance is useful as a predictor of ‘best PEEP’ |
| Key Words:
ARDS, Compliance, Oxygen transport, PEEP, Pulmonary embolism |
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