Wielkość dynamicznego PEEP w czasie zmiany pozycji ciała u chorych w trakcie wentylacji wspomaganej

Zbigniew Szkulmowski, Przemysław Słomkowski, Małgorzata Bała

Summary
Background. Dynamic intrinsic PEEP (PEEPidyn) can be caused by dynamic hyperinflation of the lung and expiratory flow limitation. It can considerably influence the work of breathing in patients with acute respiratory failure (ARF). Methods. We have assessed the effects of supine and sitting positions during pressure support ventilation on PEEPidyn in fourteen adult ARF patients, treated in an intensive care unit in a university medical centre. Respiratory mechanics and central venous pressure (CVP), as an indirect measurement of the intrapleural pressure, were measured using the PCL-818S (American Advantech Corp, Sunnyvale, CA) computerized system. PEEPidyn was determined from the negative deflection on the CVP curve ranging from the onset of inspiration to the zero flow point, and noted in three positions: supine (supine 1); after 5 minutes of ventilation in the sitting position (sitting); and immediately after changing the patient´s position back to supine (supine 2). Results. No significant differences were observed between the values of PEEPidyn in the different body positions. Conclusion. Despite common belief, the value of PEEPi is not a significant factor influencing respiratory mechanics and gas exchange in sitting, ventilated patients.

To jest tylko fragment artykułu. Aby przeczytać całość, przejdź do Czytelni medycznej.