[Hemodynamic and ventilatory complications of mechanical ventilation with high intrinsic positive end-expiratory pressure].
In three mechanically ventilated patients ventilatory and circulatory complications resulted from high levels of intrinsic positive end-expiratory pressure (PEEPi): progressive pulmonary hyperinflation due to impairment of the expiration. PEEPi was initially not considered as the cause of shock and low tidal volumes and/or high inflation pressures. In a 74-year-old man the circulation deteriorated further when hand bagging was started in an attempt to improve his ventilatory condition; after reduction of the respiration rate, he recovered well. In a 40-year-old woman with relapsing polychondritis sedation helped to reduce the respiratory rate so as to restore sufficient expiratory time. A 59-year-old woman developed acute exacerbation of severe chronic obstructive pulmonary disease, and went into shock during interhospital ambulance transport; she was stabilized after recognition of PEEPi and adjustment of the setting of the ventilator. Detection of PEEPi (e.g. by the finding of a deep inflation level on physical examination) is more important than exact measurement of PEEPi. If PEEPi is detected, the ventilator should be set at PEEP at 80-90% of PEEPi, low frequency (e.g. 8/min) and a long expiratory time, and high inspiratory flow.
Komdeur
R
R
Academisch Ziekenhuis, afd. Interne Geneeskunde, Intensive Care Beademing, Groningen.
van der Werf
T S
TS
Ligtenberg
J J
JJ
Tulleken
J E
JE
Zijlstra
J G
JG
D000328:Adult; D000368:Aged; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications; D008297:Male; D008875:Middle Aged; D011081:Polychondritis, Relapsing / Q000150:complications; D011175:Positive-Pressure Respiration / Q000379:methods; D018467:Positive-Pressure Respiration, Intrinsic / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D016896:Treatment Outcome