title: End-expiratory lung volume during mechanical ventilation: a comparison with reference values and the effect of positive end-expiratory pressure in intensive care unit patients with different lung conditions.
abstract: BACKGROUND
  Functional residual capacity (FRC) reference values are obtained from spontaneous breathing patients, and are measured in the sitting or standing position. During mechanical ventilation FRC is determined by the level of positive end-expiratory pressure (PEEP), and it is therefore better to speak of end-expiratory lung volume. Application of higher levels of PEEP leads to increased end-expiratory lung volume as a result of recruitment or further distention of already ventilated alveoli. The aim of this study was to measure end-expiratory lung volume in mechanically ventilated intensive care unit (ICU) patients with different types of lung pathology at different PEEP levels, and to compare them with predicted sitting FRC values, arterial oxygenation, and compliance values.
  
  
  METHODS
  End-expiratory lung volume measurements were performed at PEEP levels reduced sequentially (15, 10 and then 5 cmH2O) in 45 mechanically ventilated patients divided into three groups according to pulmonary condition: normal lungs (group N), primary lung disorder (group P), and secondary lung disorder (group S).
  
  
  RESULTS
  In all three groups, end-expiratory lung volume decreased significantly (P < 0.001) while PEEP decreased from 15 to 5 cmH2O, whereas the ratio of arterial oxygen tension to inspired oxygen fraction did not change. At 5 cmH2O PEEP, end-expiratory lung volume was 31, 20, and 17 ml/kg predicted body weight in groups N, P, and S, respectively. These measured values were only 66%, 42%, and 34% of the predicted sitting FRC. A correlation between change in end-expiratory lung volume and change in dynamic compliance was found in group S (P < 0.001; R2 = 0.52), but not in the other groups.
  
  
  CONCLUSIONS
  End-expiratory lung volume measured at 5 cmH2O PEEP was markedly lower than predicted sitting FRC values in all groups. Only in patients with secondary lung disorders were PEEP-induced changes in end-expiratory lung volume the result of derecruitment. In combination with compliance, end-expiratory lung volume can provide additional information to optimize the ventilator settings.
authors.affiliation: Department of Intensive Care Medicine, Erasmus MC, 's Gravendijkwal 230, 3015 CERotterdam, The Netherlands. i.bikker@erasmusmc.nl
authors.forename: Ido G
authors.initials: IG
authors.lastname: Bikker
authors.forename: Jasper
authors.initials: J
authors.lastname: van Bommel
authors.forename: Dinis
authors.initials: D
authors.lastname: Reis Miranda
authors.forename: Jan
authors.initials: J
authors.lastname: Bakker
authors.forename: Diederik
authors.initials: D
authors.lastname: Gommers
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008170:Lung Compliance / Q000502:physiology; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods; D012016:Reference Values; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000503:physiopathology*; D015656:Respiratory Mechanics / Q000502:physiology; D012189:Retrospective Studies; D013990:Tidal Volume / Q000502:physiology