High Level Positive End Expiratory Pressure (Peep) in Acute Respiratory Insufficiency

Kirby, Robert R.; Downs, John B.; Civetta, Joseph M.; Modell, Jerome H.; Dannemiller, Francis J.; Klein, E. F.; Hodges, Michael J.

doi:10.1097/00132586-197604000-00002

Cited by 192 publications

(48 citation statements)

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“…It is important, however, to stress the inference that "most recruitment" occurs around the lower inflection point region was drawn from oxygenation data, without any direct evidence. Moreover, this concept has been challenged both on the clinical evidence that additional oxygenation (and recruitment) may be obtained in some patients at PEEP levels well above those typically recorded for the lower inflection point (16,17) and on a theoretical argument attempting to explain the contours of the composite VP curve (10, 11). Figure 7.…”

Section: Inflation and Recruitmentmentioning

confidence: 99%

Recruitment and Derecruitment during Acute Respiratory Failure

Crotti

Mascheroni

Caironi

et al. 2001

Am J Respir Crit Care Med

512

297

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In a model of acute lung injury, we showed that positive end-expiratory pressure (PEEP) and tidal volume (VT) are interactive variables that determine the extent of lung recruitment, that recruitment occurs across the entire range of total lung capacity, and that superimposed pressure is a key determinant of lung collapse. Aiming to verify if the same rules apply in a clinical setting, we randomly ventilated five ALI/ARDS patients with 10, 15, 20, 30, 35, and 45 cm H2O plateau pressure and 5, 10, 15, and 20 cm H2O of PEEP. For each PEEP-VT condition, we obtained computed tomography at end inspiration and end expiration. We found that recruitment occurred along the entire volume-pressure curve, independent of lower and upper inflection points, and that estimated threshold opening pressures were normally distributed (mode = 20 cm H2O). Recruitment occurred progressively from nondependent to dependent lung regions. Overstretching was not associated with hyperinflation. Derecruitment did not parallel deflation, and estimated threshold closing pressures were normally distributed (mode = 5 cm H2O). End-inspiratory and end-expiratory collapse were correlated, suggesting a plateau-PEEP interaction. When superimposed gravitational pressure exceeded PEEP, end-expiratory collapse increased. We concluded that the rules governing recruitment and derecruitment equally apply in an oleic acid model and in human ALI/ARDS.

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Section: Inflation and Recruitmentmentioning

confidence: 99%

Recruitment and Derecruitment during Acute Respiratory Failure

Crotti

Mascheroni

Caironi

et al. 2001

Am J Respir Crit Care Med

512

297

View full text Add to dashboard Cite

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“…Additionally, BALF from patients with ARDS contained elevated concentrations of CXCL8, CXCL5, and CXCL1 and these ELR þ CXC chemokines were biologically active and correlated positively with increased BALF neutrophilia (95,(203)(204)(205)(206)(207)(208). Furthermore, elevated CXCL8 levels correlated with the development of ARDS in an at-risk patient group and CXCL8 levels declined with time in patients who survived ARDS (209,210). Moreover, animal models of ALI/ARDS have demonstrated elevated lung levels of multiple ELR þ CXC chemokines in association with lung neutrophilia and injury.…”

Section: The Role Of Chemokines and Chemokine Receptorsmentioning

confidence: 97%

Ventilator-Induced Lung Injury

Kim¹

2006

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“…In 1975, Kirby et al [33] reported that therapy with PEEP at levels above 25 cm H 2 O markedly improved survival in 28 patients with severe ARDS. The authors also concluded that this treatment was a fundamental means of aborting or reversing the primary pathophysiologic processes producing acute failure.…”

Section: Peepmentioning

confidence: 99%

Respirator management of sepsis-related respiratory failure

Chiumello

Cressoni²

2009

Curr Infect Dis Rep

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The first description of acute respiratory distress syndrome (ARDS) in adults appeared in 1967 and was characterized by dyspnea, hypoxemia, diffuse alveolar infiltrates, and reduced respiratory system compliance. ARDS and acute lung injury (ALI) syndrome have no specific treatment, only supportive care: treating the underlying cause, when possible, and using mechanical ventilation. Historically, mechanical ventilation applied normal/large tidal volumes and low levels of positive end-expiratory pressure (PEEP). Experimental data showed that a high-volume, high-pressure ventilation strategy may lead to lung lesions indistinguishable from ARDS. Subsequent randomized clinical trials showed improved survival using low tidal volumes (6 vs 12 mL/kg ideal body weight) and limiting plateau pressure to 30 cm H(2)O, although the optimal level of PEEP remains controversial. Prone positioning should be reserved for severely ill patients. Inhaled nitric oxide, which is a pulmonary vasodilator with anti-inflammatory properties, is associated with limited improvement in oxygenation without improvement in survival.

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High Level Positive End Expiratory Pressure (Peep) in Acute Respiratory Insufficiency

Cited by 192 publications

References 0 publications

Recruitment and Derecruitment during Acute Respiratory Failure

Recruitment and Derecruitment during Acute Respiratory Failure

Ventilator-Induced Lung Injury

Respirator management of sepsis-related respiratory failure

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