Time to reach a new steady state after changes of positive end expiratory pressure

D. Chiumello, S. Coppola, S. Froio, C. Mietto, L. Brazzi, E. Carlesso, L. Gattinoni

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Purpose: To assess the time interval required to reach a new steady state of oxygenation-, ventilation-, respiratory mechanics- and hemodynamics-related variables after decreasing/increasing positive end expiratory pressure (PEEP). Methods: In 23 patients (group 1) with acute respiratory distress syndrome (ARDS), PEEP was decreased from 10 to 5 cmH2O and, after 60′, it was increased from 5 to 15 cmH2O. In 21 other ARDS patients (group 2), PEEP was increased from 10 to 15 cmH2O and, after 60′, decreased from 15 to 5 cmH2O. Oxygenation, ventilation, respiratory mechanics and hemodynamic variables were recorded at time 5′, 15′, 30′ and 60′ after each PEEP change. Results: When PEEP was decreased, PaO2, PaO2/FiO2, venous admixture and arterial oxygen saturation reached their equilibrium after 5′. In contrast, when PEEP was increased, the equilibrium was not reached even after 60′. The ventilation-related variables did not change significantly with PEEP. The respiratory system compliance, when PEEP was decreased, significantly worsened only after 60′. Hemodynamics did not change significantly with PEEP. In the individual patients the change of oxygenation-related variables and of respiratory system compliance observed after 5′ could predict the changes recorded after 60′. This was not possible for PaCO2. Conclusions: We could not find a unique equilibration time for all the considered variables. However, in general, a decremental PEEP test requires far lower equilibrium time than an incremental PEEP test, suggesting a different time course for derecruitment and recruitment patterns.

Original languageEnglish
Pages (from-to)1377-1385
Number of pages9
JournalIntensive Care Medicine
Volume39
Issue number8
DOIs
Publication statusPublished - Aug 2013

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Positive-Pressure Respiration
Respiratory Mechanics
Ventilation
Hemodynamics
Adult Respiratory Distress Syndrome
Respiratory System
Compliance
Oxygen

Keywords

  • ARDS
  • PaO/FiO
  • Positive end expiratory pressure (PEEP)
  • Respiratory system mechanics

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Chiumello, D., Coppola, S., Froio, S., Mietto, C., Brazzi, L., Carlesso, E., & Gattinoni, L. (2013). Time to reach a new steady state after changes of positive end expiratory pressure. Intensive Care Medicine, 39(8), 1377-1385. https://doi.org/10.1007/s00134-013-2969-x

Time to reach a new steady state after changes of positive end expiratory pressure. / Chiumello, D.; Coppola, S.; Froio, S.; Mietto, C.; Brazzi, L.; Carlesso, E.; Gattinoni, L.

In: Intensive Care Medicine, Vol. 39, No. 8, 08.2013, p. 1377-1385.

Research output: Contribution to journalArticle

Chiumello, D, Coppola, S, Froio, S, Mietto, C, Brazzi, L, Carlesso, E & Gattinoni, L 2013, 'Time to reach a new steady state after changes of positive end expiratory pressure', Intensive Care Medicine, vol. 39, no. 8, pp. 1377-1385. https://doi.org/10.1007/s00134-013-2969-x
Chiumello D, Coppola S, Froio S, Mietto C, Brazzi L, Carlesso E et al. Time to reach a new steady state after changes of positive end expiratory pressure. Intensive Care Medicine. 2013 Aug;39(8):1377-1385. https://doi.org/10.1007/s00134-013-2969-x
Chiumello, D. ; Coppola, S. ; Froio, S. ; Mietto, C. ; Brazzi, L. ; Carlesso, E. ; Gattinoni, L. / Time to reach a new steady state after changes of positive end expiratory pressure. In: Intensive Care Medicine. 2013 ; Vol. 39, No. 8. pp. 1377-1385.
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