Continuous Positive Pressure Ventilation and Oxygen Delivery

Philbin, Daniel M.; Patterson, R. W.; Baratz, Robert A.

doi:10.1093/bja/44.7.667

Cited by 7 publications

(3 citation statements)

References 8 publications

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“…PEEP is known as a two-edged sword because of its potential negative effect on venous return and cardiac output. Total oxygen delivery to the tissues may be reduced in spite of increased arterial Poz (PHILBIN et al 1972). However, only a moderate increase in central venous pressure was observed in the present study.…”

Section: Cppv and Peepcontrasting

confidence: 79%

Pulmonary Aspiration of Acid: An Experimental Study on Cats

Vaage

Hauge

1974

Acta Anaesthesiol Scand

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Acid aspiration is followed by a moderate to severe fall in systemic arterial blood pressure, and it has been suggested that release from the lung parenchyma of vasoactive substances may be an important causal factor. We have tested this hypothesis by twice establishing cross circulation between one cat which received hydrochloric acid (4 ml/kg b.w., pH 1.5) intratracheally and another, untreated cat. Instillation of acid caused an immediate fall in heart rate and arterial blood pressure of the aspiration animal, suggesting a reflex inhibition of the heart triggered within the lung. Cross circulation with the untreated animal did not improve the situation of the aspiration animal; nor did it cause any change in arterial blood pressure or lung mechanics in the untreated animal, although most of the blood volumes of the two animals was exchanged. In a separate series of experiments including four cats, we investigated the relative advantages of various patterns of positive pressure ventilation in the treatment of the aspiration syndrome. Early onset of positive pressure ventilation (PPV) with a moderate positive end‐expiratory pressure (PEEP) (+ 6 cmH2O) was an effective treatment. We conclude that local lung tissue injury with a secondary fall in estimated dynamic lung compliance and arterial pH and Po2 is the most important feature in the pathophysiology of aspiration.

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Section: Cppv and Peepcontrasting

confidence: 79%

Pulmonary Aspiration of Acid: An Experimental Study on Cats

Vaage

Hauge

1974

Acta Anaesthesiol Scand

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“…It has long been known that IPPV diminishes cardiac output (COURNAND et al 1948). PEEP may further enhance such an effect and actually diminish the amount of delivered oxygen in spite of an increased Paoz (PHILBIN et al 1972, LUTCH & MURRAY 1972, KING et al 1973. Positive end-expiratory pressure must therefore be used with caution and not indiscriminately applied to all patients on respirator treatment.…”

Section: Discussionmentioning

confidence: 99%

“…( I967), numerous reports have documented the value of the method (UZAWA & ASHBAUGH 1969, MCINTYRE et al 1969, KUMAR et al 1970, SUGERMAN et al 1972, especially in patients with interstitial pulmonary oedema, acute chest trauma and similar conditions associated with an impaired ventilation/perfusion ratio. It also is evident from the literature that even if arterial oxygen tension may be improved, this does not necessarily imply an improvement in overall oxygen delivery (LUTCH & MURRAY 1972, PHILBIN et al 1972. The application of PEEP to patients after cardiac surgery merits special attention in this respect.…”

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confidence: 99%

Positive End‐Expiratory Pressure Ventilation After Open‐Heart Surgery

Drugge

Norlander

Olsson

et al. 1974

Acta Anaesthesiol Scand

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Thirty-seven patients were studied after open-heart surgery in relation to the effect of positive end-expiratory pressure ventilation (PEEP) as compared to routine intermittent positive pressure ventilation (IPPV) with the Engstrom Respirator. The patients were divided in two groups with 21 patients receiving PEEP and 16 IPPV. Arterial oxygen tensions and inspiratory oxygen fractions were determined 1 h after surgery and 1 day later. During the first postoperative night, the respirator settings were not changed. Inspired oxygen fractions were kept constant. PEEP between + 5 to + 10 cmHeO was used. In 11 patients, functional residual capacity (FRC) was measured preoperatively and on the first postoperative day. Statistical analyses showed no significant changes in arterial oxygen tension or in the alveolararterial oxygen differences between the two groups. FRC was slightly disminished, but no correlation was found in relation to changes in arterial oxygen tensions. It is concluded that after uneventful open-heart surgery, when careful attention is paid to maintenance of circulation and avoidance of overhydration, PEEP does not have any advantage over IPPV with a volume controlled ventilator. PEEP should, therefore, be reserved for patients with interstitial pulmonary oedema with alveolar "oxygen-block" or those in whom measures to improve pulmonary perfmion have not succeeded.

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