Effects of positive end expiratory pressure level on end-expiratory lung volume during assisted ventilation in chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

QIN Zhaohui ¹ ,  CHEN Rongchang ² , ZHONG Nanshan ²

Department of Respiratory Disease，Yuhuanding Hospital.Yantai，Shangdong，264001，ChinaCorresponding author：CHEN Rong-chang，E-mail：chenrc99@163.com;

Corresponding author：

CHEN Rongchang, Email: chenrc99@163.com

Keywords：

Chronic obstructive pulmonary disease; Positive end-expiratory pressure; Lung volume

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Objective To investigate the effects of positive end-expiratory pressure (PEEP) level on end-expiratory lung volume (EELV) during assisted ventilation in chronic obstructive pulmonary disease （COPD） patients，to provide physiological evidence to guide optimal setting of PEEP level in clinical practice.Methods Eight intubated patients with acute exacerbation of COPD were recruited for the study when the patients were in relatively stable condition after treatment.The static intrinsic PEEP (PEEPistat) and dynamic intrinsic PEEP (PEEPidyn) were measured by using airway occlusion method and esophageal balloon-tipped catheter technique,respectively.Changes in EELV (ΔEELV) were measured with inspiratory capacity (IC) method.Relations between PEEP level and ΔEELV were analyzed by curve estimation method.Results ΔEELV as a function of level of PEEP was shown as a sigmoid model.The low inflection points of the curves when PEEP levels were expressed as PEEP/PEEPistat ratio，PEEP/PEEPidyn ratio or actual PEEP setting (PEEP-a) were 0.74，0.76 or 3.6 cm H2O,respectively.The corresponding ΔEELV expressed as ΔEELV/IC（%） were 9.6%，9.1% and 7.4%,respectively.Conclusions In AECOPD patients demanding mechanical ventilation，the changes of lung volume (ΔEELV) in response to progressive increase of PEEP level were shown to be a sigmoid model.Setting PEEP level at 0.74 of PEEPistat，or 0.76 of PEEPidyn can avoid the steep increase of lung volume.

Citation： QIN Zhaohui,CHEN Rongchang,ZHONG Nanshan. Effects of positive end expiratory pressure level on end-expiratory lung volume during assisted ventilation in chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2007, 6(1): 23-26. doi: Copy

1.	俞森洋，主编.现代机械通气的监护和临床应用.北京：中国协和医科大学出版社，2000.175-191.
2.	Haluszka J，Chartrand DA，Grassino AE，et al.Intrinsic PEEP and arterial PCO2 in stable patients with chronic obstructive pulmonary disease.Am Rev Respir Dis，1990，141：1194-1197.
3.	秦朝辉，陈荣昌，钟南山.慢性阻塞性肺疾病内源性呼气末正压的生理学效应及临床对策.中国呼吸与危重监护杂志，2004，3：126-128.
4.	Rossi A，Brandolese R，Milic-Emili J，et al.The role of PEEP in patients with chronic obstructive pulmonary disease during assisted ventilation.Eur Respir J，1990，3：818-822.
5.	Ranieri VM，Giuliani R，Cinnella G，et al.Physiologic effects of positive end-expiratory pressure in patients with chronic obstructive pulmonary disease during acute ventilatory failure and controlled mechanical ventilation.Am Rev Respir Dis，1993，147：5-13.
6.	Georgopoulos D，Giannouli E，Patakas D.Effects of extrinsic positive end-expiratory pressure on mechanically ventilated patients with chronic obstructive pulmonary disease and dynamic hyperinflation.Intensive Care Med，1993，19：197-203.
7.	Guerin C，Milic-Emili J，Fournier G.Effect of PEEP on work of breathing in mechanically ventilated COPD patient.Intensive Care Med，2000，26：1207-1214.
8.	O’Donoghue FJ，Catcheside PG，Jordan AS，et al.Effect of CPAP on intrinsic PEEP，inspiratory effort，and lung volume in severe stable COPD.Thorax，2002，57：533-539.
9.	Appendini L，Purro A，Patessio A，et al.Partitioning of inspiratory muscle workload and pressure assistance in ventilator-dependent COPD patients.Am J Respir Crit Care Med，1996，154：1301-1309.
10.	Appendini L，Patessio A，Zanaboni S，et al.Physiologic effect of positive end-expiratory pressure and mask pressure support exacerbation of chronic obstructive pulmonary disease.Am J Respir Crit Care Med，1994，149：1069-1076.
11.	Nava S，Bruschi C，Rubini F，et al.Respiratory response and inspiratory effort during pressure support ventilation in COPD patients.Intensive Care Med，1995，21：871-879.
12.	中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南.中华内科杂志，2002，41：640-646.
13.	Maltais F，Reissmann H，Navalesi P，et al.Comparison of static and dynamic measurement of intrinsic PEEP in mechanically ventilated patients.Am J Respir Crit Care Med，1994，150：1318-1324.
14.	Petrof BJ，Legare M，Goldberg P，et al.Continuos positive airway pressure reduces work of breathing and dyspnea during weaning from mechanical ventilation in severe chronic obstructive pulmonary disease.Am Rev Respir Dis，1990，141：281-289.
15.	Sydow M，Golisch W，Buscher H，et al.Effect of low-level PEEP on inspiratory work of breathing in intubated patients，both with healthy lungs and with COPD.Intensive Care Med，1995，21：887-895.
16.	Zakynthinos SG，Vassilakopoulos T，Zakynthinos E，et al.Correcting static intrinsic positive end-expiratory pressure for expiratory muscle contraction：Validation of a new method.Am J Respir Crit Care Med，1999，160：785-790.

1. 俞森洋，主编.现代机械通气的监护和临床应用.北京：中国协和医科大学出版社，2000.175-191.
2. Haluszka J，Chartrand DA，Grassino AE，et al.Intrinsic PEEP and arterial PCO2 in stable patients with chronic obstructive pulmonary disease.Am Rev Respir Dis，1990，141：1194-1197.
3. 秦朝辉，陈荣昌，钟南山.慢性阻塞性肺疾病内源性呼气末正压的生理学效应及临床对策.中国呼吸与危重监护杂志，2004，3：126-128.
4. Rossi A，Brandolese R，Milic-Emili J，et al.The role of PEEP in patients with chronic obstructive pulmonary disease during assisted ventilation.Eur Respir J，1990，3：818-822.
5. Ranieri VM，Giuliani R，Cinnella G，et al.Physiologic effects of positive end-expiratory pressure in patients with chronic obstructive pulmonary disease during acute ventilatory failure and controlled mechanical ventilation.Am Rev Respir Dis，1993，147：5-13.
6. Georgopoulos D，Giannouli E，Patakas D.Effects of extrinsic positive end-expiratory pressure on mechanically ventilated patients with chronic obstructive pulmonary disease and dynamic hyperinflation.Intensive Care Med，1993，19：197-203.
7. Guerin C，Milic-Emili J，Fournier G.Effect of PEEP on work of breathing in mechanically ventilated COPD patient.Intensive Care Med，2000，26：1207-1214.
8. O’Donoghue FJ，Catcheside PG，Jordan AS，et al.Effect of CPAP on intrinsic PEEP，inspiratory effort，and lung volume in severe stable COPD.Thorax，2002，57：533-539.
9. Appendini L，Purro A，Patessio A，et al.Partitioning of inspiratory muscle workload and pressure assistance in ventilator-dependent COPD patients.Am J Respir Crit Care Med，1996，154：1301-1309.
10. Appendini L，Patessio A，Zanaboni S，et al.Physiologic effect of positive end-expiratory pressure and mask pressure support exacerbation of chronic obstructive pulmonary disease.Am J Respir Crit Care Med，1994，149：1069-1076.
11. Nava S，Bruschi C，Rubini F，et al.Respiratory response and inspiratory effort during pressure support ventilation in COPD patients.Intensive Care Med，1995，21：871-879.
12. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南.中华内科杂志，2002，41：640-646.
13. Maltais F，Reissmann H，Navalesi P，et al.Comparison of static and dynamic measurement of intrinsic PEEP in mechanically ventilated patients.Am J Respir Crit Care Med，1994，150：1318-1324.
14. Petrof BJ，Legare M，Goldberg P，et al.Continuos positive airway pressure reduces work of breathing and dyspnea during weaning from mechanical ventilation in severe chronic obstructive pulmonary disease.Am Rev Respir Dis，1990，141：281-289.
15. Sydow M，Golisch W，Buscher H，et al.Effect of low-level PEEP on inspiratory work of breathing in intubated patients，both with healthy lungs and with COPD.Intensive Care Med，1995，21：887-895.
16. Zakynthinos SG，Vassilakopoulos T，Zakynthinos E，et al.Correcting static intrinsic positive end-expiratory pressure for expiratory muscle contraction：Validation of a new method.Am J Respir Crit Care Med，1999，160：785-790.

Chinese Journal of Respiratory and Critical Care Medicine

Effects of positive end expiratory pressure level on end-expiratory lung volume during assisted ventilation in chronic obstructive pulmonary disease

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