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Research ArticleConference Proceedings

Measurement of Air Trapping, Intrinsic Positive End-Expiratory Pressure, and Dynamic Hyperinflation in Mechanically Ventilated Patients

Lluís Blanch, Francesca Bernabé and Umberto Lucangelo
Respiratory Care January 2005, 50 (1) 110-124;
Lluís Blanch
Critical Care Center, Hospital de Sabadell, Institut Universitari Fundaciò Parc Taulì, Corporaciò Parc Taulì, Universitad Autònoma de Barcelona, Sabadell, Spain.
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  • For correspondence: [email protected]
Francesca Bernabé
Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Cattinara Hospital, Trieste, Italy.
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Umberto Lucangelo
Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Cattinara Hospital, Trieste, Italy.
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Abstract

Severe airflow obstruction is a common cause of acute respiratory failure. Dynamic hyperinflation affects tidal ventilation, increases airways resistance, and causes intrinsic positive end-expiratory pressure (auto-PEEP). Most patients with asthma and chronic obstructive pulmonary disease have dynamic hyperinflation and auto-PEEP during mechanical ventilation, which can cause hemodynamic compromise and barotrauma. Auto-PEEP can be identified in passively breathing patients by observation of real-time ventilator flow and pressure graphics. In spontaneously breathing patients, auto-PEEP is measured by simultaneous recordings of esophageal and flow waveforms. The ventilatory pattern should be directed toward minimizing dynamic hyperinflation and auto-PEEP by using small tidal volume and preserving expiratory time. With a spontaneously breathing patient, to reduce the work of breathing and improve patient-ventilator interaction, it is crucial to set an adequate inspiratory flow, inspiratory time, trigger sensitivity, and ventilator-applied PEEP. Ventilator graphics are invaluable for monitoring and treatment decisions at the bedside.

  • dynamic hyperinflation
  • intrinsic positive airway pressure
  • mechanical ventilation
  • positive end-expiratory pressure
  • work of breathing
  • hyperinflation
  • waveforms

Footnotes

  • Correspondence: Lluís Blanch MD PhD, Critical Care Center, Hospital de Sabadell, Institut Universitari Fundaciò Parc Taulì, Corporaciò Parc Taulì, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain. Email: lblanch{at}cspt.es.
  • Copyright © 2005 by Daedalus Enterprises Inc.
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Respiratory Care: 50 (1)
Respiratory Care
Vol. 50, Issue 1
1 Jan 2005
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Measurement of Air Trapping, Intrinsic Positive End-Expiratory Pressure, and Dynamic Hyperinflation in Mechanically Ventilated Patients
Lluís Blanch, Francesca Bernabé, Umberto Lucangelo
Respiratory Care Jan 2005, 50 (1) 110-124;

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Measurement of Air Trapping, Intrinsic Positive End-Expiratory Pressure, and Dynamic Hyperinflation in Mechanically Ventilated Patients
Lluís Blanch, Francesca Bernabé, Umberto Lucangelo
Respiratory Care Jan 2005, 50 (1) 110-124;
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Keywords

  • dynamic hyperinflation
  • intrinsic positive airway pressure
  • mechanical ventilation
  • positive end-expiratory pressure
  • work of breathing
  • hyperinflation
  • waveforms

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