Mechanical work on the lungs and work of breathing with positive end-expiratory pressure and continuous positive airway pressure.

The mechanical work on the lung required during spontaneous breathing with positive end-expiratory pressure (PEEP) was compared with different methods of continuous positive airway pressure (CPAP) in nine young healthy athletes (surfers) at levels of 5, 10, 15, and 20 cm H2O. At the level of 20 cm H2O, PEEP increased the mean total work per minute by 116 percent and the total work per liter by 121 percent. The percent increase rose linearly with the level of PEEP. In contrast, with methods of CPAP that maintained the airway pressure (Paw) constant, the total work per minute decreased by 45 per cent at a PEEP of 10 cm H2O and remained at this level with PEEP of 15 and 20 cm H2O. Use of PEEP did not increase the functional residual capacity (FRC) in these spontaneously breathing subjects. In contrast, CPAP resulted in a rise in FRC proportional to the level of CPAP. This suggests that CPAP must be applied in a manner that maintains Paw constant to provide optimal assistance to ventilation.