Physiologic Consequences of Positive End-Expiratory Pressure (PEEP) Ventilation

Powers, Samuel R.; Mannal, R.; M, Neclerio; English, Mark; Marr, Clifford C.; Leather, Robert P.; Ueda, H; Williams, G.; Custead, Wayne G.; Dutton, Robert E.

doi:10.1097/00000658-197309000-00005

Cited by 264 publications

(55 citation statements)

References 6 publications

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“…In applying these, some authors have suggested that the influence of coupling or linkage is minimal [24,75]. Others have found the correlation between oxygen consumption determined by the Fick method and oxygen delivery was almost wholly due to mathematical coupling.…”

Section: Linkagementioning

confidence: 99%

Beyond the lung: oxygen delivery and tissue oxygenation

Soni¹,

Fawcett²,

Halliday³

1993

Anaesthesia

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Section: Linkagementioning

confidence: 99%

Beyond the lung: oxygen delivery and tissue oxygenation

Soni¹,

Fawcett²,

Halliday³

1993

Anaesthesia

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“…It is well known that PPV and/or PEEP can decrease cardiac output. 9 We did not measure mixed venous oxygen saturation or cardiac output in our patient. Thus, the mechanism responsible for the ventilation-related changes in oxygenation is speculative.…”

Section: Discussionmentioning

confidence: 93%

Pulmonary arteriovenous fistula: mechanical ventilation and hypoxemia

1992

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“…[13][14][15] The final PEEP level was maintained for at least 10 minutes. A second set of DO 2 and VO 2 measurements was taken at this reduced CO.…”

Section: Methodsmentioning

confidence: 99%

Is there occult tissue ischemia in chronic end-stage liver disease?

et al. 1999

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Whether pathological oxygen supply dependency exists in patients with chronic end-stage liver disease (CESLD) is unknown, although the frequently occurring multiorgan dysfunction seen in these patients may be the result of occult tissue ischemia. In this study, 15 adult patients with CESLD were evaluated for the presence of pathological oxygen supply dependency and, thus, occult tissue ischemia before undergoing orthotopic liver transplantation. Whole-body oxygen consumption (VO 2 ) was measured using indirect calorimetry at baseline, at reduced oxygen delivery (DO 2 ) using positive end-expiratory pressure, and at increased DO 2 using volume infusion. As a group, no significant increase or decrease in VO 2 was observed with changes in DO 2 . However, 4 patients showed increases in VO 2 of 14%, 10.8%, 9.6%, and 8.2% when DO 2 was increased. The study results suggest that pathological oxygen supply dependency is present in a subset of patients with CESLD, and the existence of occult tissue ischemia is speculated. Copyright 1999 by the American Association for the Study of Liver DiseasesU nder normal conditions, whole-body oxygen consumption (VO 2 ) is independent of oxygen delivery (DO 2 ) over a wide range of DO 2 values. As DO 2 decreases from normal levels, oxygen extraction from hemoglobin (Hgb) increases, preserving VO 2 . However, if DO 2 decreases to less than a critical level, VO 2 begins to decrease as oxygen extraction reaches its physiological maximum. This is termed physiological oxygen supply dependency. It has been suggested that in certain disease states, such as adult respiratory distress syndrome (ARDS), 1-4 sepsis, 5-7 and fulminant hepatic failure (FHF), 8 pathological oxygen supply dependency may exist. In this condition, also known as pathological DO 2 dependency, increases in DO 2 to greater than normal or even supranormal levels result in progressive increases in VO 2 , with relative preservation of oxygen extraction. Explanations for this seemingly inappropriate DO 2 dependency remain speculative, but ongoing occult tissue ischemia cannot be conclusively excluded. Although a number of studies have been performed suggesting the presence of pathological DO 2 dependency, inherent methodological flaws, most frequently the use of mathematically coupled calculations for both DO 2 and VO 2 , have favored the false demonstration of pathological DO 2 dependency and thus render these studies inconclusive.Whether patients with chronic end-stage liver disease (CESLD) have pathological DO 2 dependency is unknown. This patient population is unique in that the presence of a hyperdynamic circulation coupled with a high mixed-venous oxygen content is suggestive of luxury capillary perfusion. It can be postulated that the hyperdynamic circulation seen in CESLD is an adaptive response to occult tissue ischemia caused by profound arteriovenous shunting with resultant inadequate organ perfusion. Thus, it is possible that the frequently occurring multiorgan dysfunction seen in CESLD is the result of occult tiss...

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Physiologic Consequences of Positive End-Expiratory Pressure (PEEP) Ventilation

Cited by 264 publications

References 6 publications

Beyond the lung: oxygen delivery and tissue oxygenation

Beyond the lung: oxygen delivery and tissue oxygenation

Pulmonary arteriovenous fistula: mechanical ventilation and hypoxemia

Is there occult tissue ischemia in chronic end-stage liver disease?

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