Regional Effects and Mechanism of Positive End-Expiratory Pressure in Early Adult Respiratory Distress Syndrome

Luciano Gattinoni, Luca D’andrea, Paolo Pelosi, Giovanni Vitale, Antonio Pesenti, Roberto Fumagalli

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Objective.—To test the hypothesis that positive end-expiratory pressure (PEEP) prevents the collapse of a given lung region when it is equal to or greater than the hydrostatic pressure superimposed (SPL) to that region. Design.—Intervention study with sequential levels of PEEP applied in random order to a cohort of patients with adult respiratory distress syndrome (ARDS). Setting.—Referral center for ARDS in a university hospital. Patients.—Ten ARDS patients (with Murray scores >2.5). Intervention.—Basal computed tomographic (CT) section taken at o, 2, 4, 5, 6, 8, 10, 12, 14, 15, and 20 cm H2O PEEP. Main Outcome Measures.—Basal lung CT sections were divided into 10 equal levels from the ventral to dorsal surfaces. In each level SPL was measured from density and height. The inflation of the level was measured as the gas/tissue ratio (g/t); g/t changes with PEEP were defined as the g/t—P curve. The slope of the g/t—P curve was defined as level compliance (ie, the ratio of change in the g/t of the level to the change in pressure). A linear g/t—P curve was the criterion to detect inflation without recruitment (ie, new pulmonary units opening at a given pressure). A biphasic g/t—P curve (change of compliance after an inflection point) was the criterion to detect recruitment. Pflex was defined as the pressure at which the inflection point occurred. Results.—The SPL increased from level 1 (ventral) to level 10 (dorsal) (r=.91; P

Original languageEnglish
Pages (from-to)2122-2127
Number of pages6
JournalJournal of the American Medical Association
Issue number16
Publication statusPublished - Apr 28 1993

ASJC Scopus subject areas

  • Medicine(all)


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