Optimum End-Expiratory Airway Pressure in Patients With Acute Pulmonary Failure

N Engl J Med. 1975 Feb 6;292(6):284-9. doi: 10.1056/NEJM197502062920604.

Abstract

To determine whether in the management of pulmonary failure, the maximum compliance produced by positive end-expiratory pressure coincides with optimum lung function, 15 normovolemic patients requiring mechanical ventilation for acute pulmonary failure were studied. The end-expiratory pressure resulting in maximum oxygen transport (cardiac output times arterial oxygen content) and the lowest dead-space fraction both resulted in the greatest total static compliance. This end-expiratory pressure varied between 0 and 15 cm of water and correlated inversely with functional residual capacity at zero end-expiratory pressure (r equal -0.72, p less than or equal to 0.005). Mixed venous oxygen tension increased between zero end-expiratory pressure and the end-expiratory pressure resulting in maximum oxygen transport, but then decreased at higher end-expiratory pressures. When measurements of cardiac output or of true mixed venous blood are not available, compliance may be used to indicate the end-expiratory pressure likely to result in optimum cardiopulmonary function.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Airway Resistance
  • Carbon Dioxide / blood
  • Cardiac Output
  • Female
  • Helium
  • Humans
  • Hydrogen-Ion Concentration
  • Lung / physiopathology
  • Lung Compliance*
  • Male
  • Middle Aged
  • Oxygen / blood
  • Positive-Pressure Respiration
  • Pressure
  • Pulmonary Emphysema / physiopathology
  • Respiration
  • Respiratory Insufficiency / physiopathology*
  • Respiratory Insufficiency / therapy
  • Spirometry

Substances

  • Carbon Dioxide
  • Helium
  • Oxygen