Physiologic effects of positive end-expiratory pressure and mask pressure support during exacerbations of chronic obstructive pulmonary disease

Lorenzo Appendini, Antonio Patessio, Silvio Zanaboni, Mauro Carone, Boris Gukov, Claudio F. Donner, Andrea Rossi

Research output: Contribution to journalArticle

Abstract

To assess physiologic effects of continuous positive airway pressure (CPAP) and positive end-expiratory pressure (PEEP) during noninvasive pressure support ventilation (PSV) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD), we measured in seven patients the breathing pattern, lung mechanics, diaphragmatic effort (PTPdi), and arterial blood gases under four conditions: (1) spontaneous breathing (SB); (2) CPAP; (3) PSV of 10 cm H 2O; and (4) PSV plus PEEP (PEEP+PSV). CPAP and PEEP were set between 80 and 90% of dynamic intrinsic PEEP (PEEPi(dyn)) measured during SB and PSV, respectively. PEEPi(dyn) was obtained (1) from the decrease in pleural pressure (ΔPpl) preceding inspiration, and (2) subtracting the fall in gastric pressure (ΔPga) caused by relaxation of the abdominal muscles from the ΔPpl decrease. Abdominal muscle activity made PEEPi(dyn) overestimated in almost all instances (p <0.0001). PSV increased minute ventilation, improved gas exchange, and decreased PTPdi. PEEP added to PSV, likewise CPAP compared with SB, further significantly decreased the diaphragmatic effort (PTPdi went from 322 ± 111 to 203 ± 63 cm H 2O · s) by counterbalancing PEEPi(dyn), which went from 5.4 ± 4.0 to 3.1 ± 2.3 cm H 2O. These data support the use of low levels of PEEP (80 to 90% of PEEPi(dyn)) to treat acute exacerbation of COPD by means of mask PSV.

Original languageEnglish
Pages (from-to)1069-1076
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume149
Issue number5
Publication statusPublished - May 1994

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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