Tracing best PEEP by applying PEEP as a RAMP.
OBJECTIVE
The aim of this study was to show the feasibility of a slow, continuously increasing level of positive end-expiratory pressure (PEEP) (ramp manoeuvre) in selecting best PEEP and to evaluate whether best PEEP, as defined by maximal oxygen transport, coincides with best systemic arterial oxygenation or best compliance.


METHODS
In 11 anaesthetized piglets, PEEP was increased between 0 cmH2O (zero end-expiratory pressure; ZEEP) and 15 cmH2O (PEEP15) with a constant rate of 0.67 cmH2O x min(-1). This ramp manoeuvre was performed both under normal conditions and after induction of an experimental lung oedema. During the ramp manoeuvre, haemodynamic and pulmonary variables were monitored almost continuously.


RESULTS
During the rise in PEEP, cardiac output declined in a non-linear way. In the series with normal conditions, best PEEP was always found at ZEEP. In the series with experimental lung oedema, best PEEP, as defined by maximum oxygen transport, was found at PEEP1-6, as defined by maximal compliance, at PEEP7.5 and by maximal arterial oxygen tension (PaO2) at PEEP10-14.


CONCLUSIONS
Best PEEP according to oxygen transport is lower than best PEEP according to compliance and PaO2; the use of PEEP as a ramp might prevent unnecessarily high levels of PEEP.
Atrium Medisch Centrum, Department of Anaesthesiology, Heerlen, The Netherlands.
C D
CD
Punt
J J
JJ
Schreuder
J R
JR
Jansen
S A
SA
Hoeksel
A
A
Versprille
D000818:Animals; D001784:Blood Gas Analysis; D004195:Disease Models, Animal; D005240:Feasibility Studies; D006439:Hemodynamics; D008991:Monitoring, Physiologic / Q000379:methods; D019095:Point-of-Care Systems / Q000592:standards; D011175:Positive-Pressure Respiration / Q000379:methods* / Q000592:standards; D011654:Pulmonary Edema / Q000097:blood / Q000628:therapy*; D012044:Regression Analysis; D013552:Swine