The effects of positive end-expiratory pressure of intrapulmonary shunt and ventilatory deadspace in nonhypoxic trauma patients.
Controversy exists regarding the routine use of positive end-expiratory pressure (PEEP) in mechanically ventilated patients. We hypothesized that nonhypoxic patients receiving 5-cm H2O PEEP would have improved shunt and PaO2/F10(2) ratios (P/F), without an increased dead space to tidal volume ratio (VD/VT) versus patients receiving no PEEP. Forty-four trauma patients were randomized to receive 5-cm H2O PEEP (PEEP) or 0-cm H2O PEEP (ZEEP). Shunt VD/VT and P/F were measured at 0, 12, 24, 36, and 48 hours after intubation and after extubation. PEEP and ZEEP comparisons used Student's t test and the General Linear Models procedure. Shunt was significantly increased at t = 0 and at extubation in the PEEP group. At extubation, the PEEP group demonstrated significantly higher VD/VT and poorer P/F ratios. After correction for baseline values, no statistically significant differences were noted in spite of a trend toward worsening pulmonary function in all measured parameters. These results suggest that routine use of 5-cm H2O PEEP in mechanical ventilated trauma patients is not necessary.
Vigil
A R
AR
Department of Surgery, University of New Mexico, Albuquerque, USA.
Clevenger
F W
FW
D000328:Adult; D006801:Humans; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D012123:Pulmonary Ventilation; D012126:Respiratory Dead Space; D014947:Wounds and Injuries / Q000503:physiopathology* / Q000628:therapy*