OBJECTIVE: To describe the behavior of inspiratory resistance components when positive end-expiratory pressure (PEEP) increases in patients with acute respiratory distress syndrome under a protective ventilation strategy. METHODS: In volume-controlled mode, at 6mL/kg and constant flow, end-inspiratory occlusions were performed at 0, 5 10, 15 and 20cmH2O PEEP. Peak, initial and plateau pressure values were assessed, calculating the maximum, minimum and differential resistances. The results were compared by repeated measures analysis of variance (ANOVA) with post hoc Bonferroni correction, considering p < 0.05 significant. RESULTS: The highest maximum resistance was observed at the lowest PEEP levels. The values for 10 and 15cmH2O PEEP significantly differed from those for 5 and 0cmH2O PEEP, whereas that for 20cmH2O PEEP only significantly differed from that for 0cmH2O PEEP (p < 0.05). The minimum resistance behaved similarly to the maximum resistance; the values for PEEP levels from 10cmH2O to 20cmH2O significantly differed from those for 0 and 5cmH2O PEEP (p < 0.05). Differential resistance showed the opposite variation to the maximum and minimum resistances. The only PEEP level that showed significant differences from 0 and 5cmH2O PEEP was 20cmH2O PEEP. Significant differences were also found between 15 and 5cmH2O PEEP (p < 0.05). CONCLUSIONS: During protective ventilation in patients with acute respiratory distress syndrome, the maximum resistance of the respiratory system decreases with PEEP, reflecting the minimum resistance response, whereas differential resistance increases with PEEP.
OBJECTIVE: To describe the behavior of inspiratory resistance components when positive end-expiratory pressure (PEEP) increases in patients with acute respiratory distress syndrome under a protective ventilation strategy. METHODS: In volume-controlled mode, at 6mL/kg and constant flow, end-inspiratory occlusions were performed at 0, 5 10, 15 and 20cmH2O PEEP. Peak, initial and plateau pressure values were assessed, calculating the maximum, minimum and differential resistances. The results were compared by repeated measures analysis of variance (ANOVA) with post hoc Bonferroni correction, considering p < 0.05 significant. RESULTS: The highest maximum resistance was observed at the lowest PEEP levels. The values for 10 and 15cmH2O PEEP significantly differed from those for 5 and 0cmH2O PEEP, whereas that for 20cmH2O PEEP only significantly differed from that for 0cmH2O PEEP (p < 0.05). The minimum resistance behaved similarly to the maximum resistance; the values for PEEP levels from 10cmH2O to 20cmH2O significantly differed from those for 0 and 5cmH2O PEEP (p < 0.05). Differential resistance showed the opposite variation to the maximum and minimum resistances. The only PEEP level that showed significant differences from 0 and 5cmH2O PEEP was 20cmH2O PEEP. Significant differences were also found between 15 and 5cmH2O PEEP (p < 0.05). CONCLUSIONS: During protective ventilation in patients with acute respiratory distress syndrome, the maximum resistance of the respiratory system decreases with PEEP, reflecting the minimum resistance response, whereas differential resistance increases with PEEP.
Authors: Roy G Brower; Michael A Matthay; Alan Morris; David Schoenfeld; B Taylor Thompson; Arthur Wheeler Journal: N Engl J Med Date: 2000-05-04 Impact factor: 91.245
Authors: L Gattinoni; A Pesenti; M L Caspani; A Pelizzola; D Mascheroni; R Marcolin; G Iapichino; M Langer; A Agostoni; T Kolobow Journal: Intensive Care Med Date: 1984 Impact factor: 17.440
Authors: Evangelia Akoumianaki; Salvatore M Maggiore; Franco Valenza; Giacomo Bellani; Amal Jubran; Stephen H Loring; Paolo Pelosi; Daniel Talmor; Salvatore Grasso; Davide Chiumello; Claude Guérin; Nicolo Patroniti; V Marco Ranieri; Luciano Gattinoni; Stefano Nava; Pietro-Paolo Terragni; Antonio Pesenti; Martin Tobin; Jordi Mancebo; Laurent Brochard Journal: Am J Respir Crit Care Med Date: 2014-03-01 Impact factor: 21.405
Authors: Daniel Talmor; Todd Sarge; Atul Malhotra; Carl R O'Donnell; Ray Ritz; Alan Lisbon; Victor Novack; Stephen H Loring Journal: N Engl J Med Date: 2008-11-11 Impact factor: 91.245