title: [Auto-PEEP effects on respiratory mechanics and blood gases in mechanically ventilated patients]
abstract: OBJECTIVE: The purpose of this study was to examine the auto-PEEP incidence and magnitude and the relationship between its reductions and changes in respiratory mechanics and gas exchanges in mechanically ventilated patients addmited in an Intensive Care Unit.METHODS: A prospective study was conducted in seventeen infants undergoing mechanical ventilation due to respiratory or neuromuscular diseases. We have measured blood gases, mean airway pressure, tidal volume, compliance, resistance and time constants of the respiratory system and monitored pressure, flow and volume waveforms and pressure-volume and flow-volume loops.RESULTS: Thirteen patients or 76% developed auto-PEEP and the reduction of its magnitude (from 5.4 -/+ 3.2 to 4.1 -/+ 2.6 cmH2O, p<0.01) showed association to mean airway pressure decrease (from 10.2 -/+ 3.1 to 9.3 -/+ 2.3 cmH2O, p<0.01), tidal volume (from 45.3 -/+ 19.1 to 51.3 -/+ 22.9 ml, p<0.01) and corrected compliance increase (1.02 -/+ 1.20 to 1.13 -/+ 1.41 ml/cmH2O/kg, p=0.05). Expiratory resistance remained unchanged (from 15.0 -/+ 8.6 to 15.7 -/+ 9.4 cmH2O/l/sec/kg, p=0.06). Arterial blood gases showed pH increase (from 7.37 -/+ 0.12 to 7.42 -/+ 0.05, p<0.05) and PCO2 and PO2 decrease (from 40.1 -/+ 11.1 mmHg to 33.1 -/+ 7.4 mmHg, p<0.01 and 65.0 -/+ 13.9 to 58.0 -/+ 12.6 mmHg, p<0.01 respectively).CONCLUSIONS: Auto-PEEP reduction was associated with pulmonary mechanics and blood gases improvement. Knowledge of auto-PEEP presence and magnitude allowed to respiratory system compliance and time constants correction, providing accurate index of the pulmonary mechanics.
authors.affiliation: Neocenter, Belo Horizonte, MG, Brazil.
authors.forename: A C
authors.initials: AC
authors.lastname: Ferreira
authors.forename: B I
authors.initials: BI
authors.lastname: Kopelman
authors.forename: W B
authors.initials: WB
authors.lastname: Carvalho
authors.forename: J
authors.initials: J
authors.lastname: Bonassa