RT Journal Article
SR Electronic
T1 A Decremental PEEP Trial Identifies the PEEP Level That Maintains Oxygenation After Lung Recruitment
JF Respiratory Care
FD American Association for Respiratory Care
SP 1132
OP 1139
VO 51
IS 10
A1 Girgis, Karim
A1 Hamed, Hala
A1 Khater, Yehia
A1 Kacmarek, Robert M
YR 2006
UL http://rc.rcjournal.com/content/51/10/1132.abstract
AB OBJECTIVE: To assess the ability of a decremental trial of positive end-expiratory pressure (PEEP) to identify an optimal PEEP level that maintains oxygenation after a lung-recruitment maneuver. DESIGN: Prospective clinical trial. SETTING: Surgical intensive care unit of a university hospital. PATIENTS: Twenty sedated patients with acute lung injury and/or acute respiratory distress syndrome, ventilated for 1.2 ± 0.4 d. INTERVENTION: Each patient received up to 3 lung-recruitment maneuvers with continuous positive airway pressure of 40 cm H2O sustained for 40 s to increase the ratio of PaO2 to FIO2 by > 20%. Following the lung-recruitment maneuver, PEEP was set at 20 cm H2O and then the FIO2 was decreased until the oxygen saturation (measured via pulse oximetry [SpO2]) was 90–94%. PEEP was then decreased in 2-cm H2O steps until the SpO2 dropped below 90%. The step preceding the drop to below 90% was considered the optimal PEEP. The lung was then re-recruited and PEEP and FIO2 were set at the identified levels. The patients were followed for 4 h after the PEEP trial and the setting of PEEP and FIO2. RESULTS: After the lung-recruitment maneuver, all the patients' PaO2/FIO2 increased > 50%. The mean ± SD PaO2/FIO2 on the optimal decremental trial PEEP was 211 ± 79 mm Hg, versus 135 ± 37 mm Hg at baseline (p < 0.001), and was sustained at that level for the 4-h study period (227 ± 81 mm Hg at 4 h). FIO2 at baseline was 0.54 ± 0.12 versus 0.38 ± 0.12 (p < 0.001) at 4 h. PEEP was 11.9 ± 3.0 cm H2O at baseline and 9.1 ± 4.7 cm H2O (p = 0.011) at 4 h. CONCLUSION: A decremental PEEP trial identifies a PEEP setting that sustains for 4 h the oxygenation benefit of a 40-cm H2O, 40-s lung-recruitment maneuver.