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Effects of PEEP on Respiratory Mechanics after Open Heart Surgery

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Presentation on theme: "Effects of PEEP on Respiratory Mechanics after Open Heart Surgery"— Presentation transcript:

1 Effects of PEEP on Respiratory Mechanics after Open Heart Surgery
Päivi Valta, M.D., Jukka Takak, M.D., Ph.D., N. Tony Elissa, M.D., Joseph Milic-Emili, C.M., M.D., F.R.S.C.  CHEST  Volume 102, Issue 1, Pages (July 1992) DOI: /chest Copyright © 1992 The American College of Chest Physicians Terms and Conditions

2 FIGURE 1 Effects of the three repeated stepwise inflation-deflation runs with PEEP (I, II, III) on end-expiratory lung volume (ΔEELV), static compliance of respiratory system (Cst, rs), and intrinsic PEEP (PEEPi). Measurements were made at zero end-expiratory pressure (ZEEP) before (start) and after each run. ΔEELV refers to changes relative to initial EELV at ZEEP. Values are mean ± SE of ten patients. Asterisk = p<0.05 versus start. CHEST  , DOI: ( /chest ) Copyright © 1992 The American College of Chest Physicians Terms and Conditions

3 FIGURE 2 Relationship between changes in lung volume (ΔV) and static elastic recoil pressure of the respiratory system (Pst, rs), obtained at end-inspiration and end-expiration in a representative patient at different levels of PEEP during the first stepwise inflation (A) and deflation (B) with PEEP. Changes in volume are expressed relative to initial end-expiratory lung volume at zero end-expiratory pressure (ZEEP). Lines are drawn between end-expiratory and end-inspiratory points obtained at different levels of PEEP. Up to PEEP of 6 cm H2O, data points fell along a fixed line. Slope of the lines represents static compliance of the respiratory system. PEEPi = intrinsic PEEP. Recruited alveolar volume with PEEP was measured as difference in volume between lowermost Une which pertains to ZEEP and Unes obtained with PEEP at Pst, rs 15 cm H2O (broken lines). For further explanations, see text. CHEST  , DOI: ( /chest ) Copyright © 1992 The American College of Chest Physicians Terms and Conditions

4 FIGURE 3 Average values of recruited alveolar volume (Vrec) and changes in end-expiratory lung volume (ΔEELV) during stepwise inflation runs 1, 2, and 3 at PEEP of 5 and 10 em H2O in ten patients, and at PEEP of 15 em H2O in three patients. Bars = 1 SE. Asterisk = p<0.001 for ΔEELV at the first PEEP level where ΔEELV was significantly different from ZEEP; dagger = p<0.001 for Vrec at the first PEEP level where Vrec was significantly different from ZEEP. CHEST  , DOI: ( /chest ) Copyright © 1992 The American College of Chest Physicians Terms and Conditions

5 FIGURE 4 Average values of static compliance of the respiratory system (Cst, rs) during stepwise inflation runs I, II, and III at three levels of PEEP in ten patients, Bars = 1 SE. Asterisk = p<0.05 versus run 1. CHEST  , DOI: ( /chest ) Copyright © 1992 The American College of Chest Physicians Terms and Conditions

6 FIGURE 5 Average values of static compliance of the respiratory system (Cst, rs), recruited alveolar volume (Vrec), and changes in end-expiratory lung volume (ΔEELV) obtained at PEEP of 5 cm H2O during inflation (filled bars) and deflation (open bars) runs I, II, and III in ten subjects. Bars = 1 SE. P values refer to comparisons between inflation and deflation. Asterisk = p<0.05; two asterisks = p<0.01. CHEST  , DOI: ( /chest ) Copyright © 1992 The American College of Chest Physicians Terms and Conditions


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