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. 1980 Mar;35(3):181–185. doi: 10.1136/thx.35.3.181

Effect of positive end-expiratory pressure on intrapulmonary shunt at different levels of fractional inspired oxygen.

A Oliven, U Taitelman, F Zveibil, S Bursztein
PMCID: PMC471250  PMID: 6770485

Abstract

In 10 patients undergoing ventilation, venous admixture was measured at different values of positive end-expiratory pressure (PEEP). The measurements were performed at the level of fractional inspired oxygen (FIO2) at which each patient was ventilated, and at FIO2=1. In patients ventilated at FIO2 between 0.21 and 0.3 venous admixture was not modified by PEEP, while in patients ventilated with FIO2 between 0.4 and 0.6, venous admixture decreased significantly (p less than 0.01). With FIO2=1, increased PEEP produced a reduction in venous admixture in all cases (p less than 0.05). These observations suggest that in patients similar to ours, PEEP does not reduce venous admixture at low levels of FIO2 (0.21--0.3), and the observed reduction with PEEP at FIO2=1 may be misinterpreted.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ashbaugh D. G., Petty T. L. Positive end-expiratory pressure. Physiology, indications, and contraindications. J Thorac Cardiovasc Surg. 1973 Jan;65(1):165–170. [PubMed] [Google Scholar]
  2. Burger E. J., Jr, Mead J. Static properties of lungs after oxygen exposure. J Appl Physiol. 1969 Aug;27(2):191–197. doi: 10.1152/jappl.1969.27.2.191. [DOI] [PubMed] [Google Scholar]
  3. Carter G. L., Downs J. B., Dannemiller F. J. "Hyper-" end-expiratory pressure in the treatment of adult respiratory insufficiency: a case report. Anesth Analg. 1975 Jan-Feb;54(1):31–34. doi: 10.1213/00000539-197501000-00005. [DOI] [PubMed] [Google Scholar]
  4. DALE W. A., RAHN H. Rate of gas absorption during atelectasis. Am J Physiol. 1952 Sep;170(3):606–613. doi: 10.1152/ajplegacy.1952.170.3.606. [DOI] [PubMed] [Google Scholar]
  5. Downs J. B., Klein E. F., Jr, Modell J. H. The effect of incremental PEEP on PaO 2 in patients with respiratory failure. Anesth Analg. 1973 Mar;52(2):210–215. [PubMed] [Google Scholar]
  6. Déry R., Pelletier J., Jacques A., Clavet M., Houde J. Alveolar collapse induced by denitrogenation. Can Anaesth Soc J. 1965 Nov;12(6):531–557. doi: 10.1007/BF03004416. [DOI] [PubMed] [Google Scholar]
  7. FARHI L. E., RAHN H. A theoretical analysis of the alveolar-arterial O2 difference with special reference to the distribution effect. J Appl Physiol. 1955 May;7(6):699–703. doi: 10.1152/jappl.1955.7.6.699. [DOI] [PubMed] [Google Scholar]
  8. FINLEY T. N., LENFANT C., HAAB P., PIIPER J., RAHN H. Venous admixture in the pulmonary circulation of anestethetized dogs. J Appl Physiol. 1960 May;15:418–424. doi: 10.1152/jappl.1960.15.3.418. [DOI] [PubMed] [Google Scholar]
  9. GOMEZ D. M. Considerations of oxygen-hemoglobin equilibrium in the physiological state. Am J Physiol. 1961 Jan;200:135–142. doi: 10.1152/ajplegacy.1961.200.1.135. [DOI] [PubMed] [Google Scholar]
  10. Georg J., Hornum I., Mellemgaard K. The mechanism of hypoxaemia after laparotomy. Thorax. 1967 Jul;22(4):382–386. doi: 10.1136/thx.22.4.382. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Gilston A. The effects of PEEP on arterial oxygenation. An examination of some possible mechanisms. Intensive Care Med. 1977 Dec;3(4):267–271. doi: 10.1007/BF01641118. [DOI] [PubMed] [Google Scholar]
  12. Gregory G. A., Kitterman J. A., Phibbs R. H., Tooley W. H., Hamilton W. K. Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure. N Engl J Med. 1971 Jun 17;284(24):1333–1340. doi: 10.1056/NEJM197106172842401. [DOI] [PubMed] [Google Scholar]
  13. Hobelmann C. F., Jr, Smith D. E., Virgilio R. W., Shapiro A. R., Peters R. M. Hemodynamic alterations with positive end-expiratory pressure: the contribution of the pulmonary vasculature. J Trauma. 1975 Nov;15(11):951–959. doi: 10.1097/00005373-197511000-00002. [DOI] [PubMed] [Google Scholar]
  14. King E. G., Jones R. L., Patakas D. A. Evaluation of positive end-expiratory pressure therapy in the adult respiratory distress syndrome. Can Anaesth Soc J. 1973 Jul;20(4):546–558. doi: 10.1007/BF03026216. [DOI] [PubMed] [Google Scholar]
  15. Kirby R. R., Downs J. B., Civetta J. M., Modell J. H., Dannemiller F. J., Klein E. F., Hodges M. High level positive end expiratory pressure (PEEP) in acute respiratory insufficiency. Chest. 1975 Feb;67(2):156–163. doi: 10.1378/chest.67.2.156. [DOI] [PubMed] [Google Scholar]
  16. Kumar A., Falke K. J., Geffin B., Aldredge C. F., Laver M. B., Lowenstein E., Pontoppidan H. Continuous positive-pressure ventilation in acute respiratory failure. N Engl J Med. 1970 Dec 24;283(26):1430–1436. doi: 10.1056/NEJM197012242832603. [DOI] [PubMed] [Google Scholar]
  17. McAslan T. C., Matjasko-Chiu J., Turney S. Z., Cowley R. A. Influence of inhalation of 100 percent oxygen on intrapulmonary shunt in severely traumatized patients. J Trauma. 1973 Sep;13(9):811–821. doi: 10.1097/00005373-197309000-00007. [DOI] [PubMed] [Google Scholar]
  18. McIntyre R. W., Laws A. K., Ramachandran P. R. Positive expiratory pressure plateau: improved gas exchange during mechanical ventilation. Can Anaesth Soc J. 1969 Nov;16(6):477–486. doi: 10.1007/BF03004541. [DOI] [PubMed] [Google Scholar]
  19. McMahon S. M., Halprin G. M., Sieker H. O. Positive end-expiratory airway pressure in severe arterial hypoxemia. Am Rev Respir Dis. 1973 Sep;108(3):526–535. doi: 10.1164/arrd.1973.108.3.526. [DOI] [PubMed] [Google Scholar]
  20. Modell J. H. Ventilation-perfusion changes during mechanical ventilation. Dis Chest. 1969 Jun;55(6):447–451. doi: 10.1378/chest.55.6.447. [DOI] [PubMed] [Google Scholar]
  21. Powers S. R., Jr, Mannal R., Neclerio M., English M., Marr C., Leather R., Ueda H., Williams G., Custead W., Dutton R. Physiologic consequences of positive end-expiratory pressure (PEEP) ventilation. Ann Surg. 1973 Sep;178(3):265–272. doi: 10.1097/00000658-197309000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. RAHN H., FARHI L. E. GASEOUS ENVIRONMENT AND ATELECTASIS. Fed Proc. 1963 Jul-Aug;22:1035–1041. [PubMed] [Google Scholar]
  23. Wagner P. D., Laravuso R. B., Uhl R. R., West J. B. Continuous distributions of ventilation-perfusion ratios in normal subjects breathing air and 100 per cent O2. J Clin Invest. 1974 Jul;54(1):54–68. doi: 10.1172/JCI107750. [DOI] [PMC free article] [PubMed] [Google Scholar]

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