NDLI: High positive end-expiratory pressure: only a dam against oedema formation?

Content Provider	Springer Nature : BioMed Central
Author	Protti, Alessandro Andreis, Davide T Iapichino, Giacomo E Monti, Massimo Comini, Beatrice Milesi, Marta Zani, Loredana Gatti, Stefano Lombardi, Luciano Gattinoni, Luciano
Abstract	Introduction Healthy piglets ventilated with no positive end-expiratory pressure (PEEP) and with tidal volume (VT) close to inspiratory capacity (IC) develop fatal pulmonary oedema within 36 h. In contrast, those ventilated with high PEEP and low VT, resulting in the same volume of gas inflated (close to IC), do not. If the real threat to the blood-gas barrier is lung overinflation, then a similar damage will occur with the two settings. If PEEP only hydrostatically counteracts fluid filtration, then its removal will lead to oedema formation, thus revealing the deleterious effects of overinflation. Methods Following baseline lung computed tomography (CT), five healthy piglets were ventilated with high PEEP (volume of gas around 75% of IC) and low VT (25% of IC) for 36 h. PEEP was then suddenly zeroed and low VT was maintained for 18 h. Oedema was diagnosed if final lung weight (measured on a balance following autopsy) exceeded the initial one (CT). Results Animals were ventilated with PEEP 18 ± 1 cmH2O (volume of gas 875 ± 178 ml, 89 ± 7% of IC) and VT 213 ± 10 ml (22 ± 5% of IC) for the first 36 h, and with no PEEP and VT 213 ± 10 ml for the last 18 h. On average, final lung weight was not higher, and actually it was even lower, than the initial one (284 ± 62 vs. 347 ± 36 g; P = 0.01). Conclusions High PEEP (and low VT) do not merely impede fluid extravasation but rather preserve the integrity of the blood-gas barrier in healthy lungs.
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc12810.pdf
Ending Page	8
Page Count	8
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc12810
Journal	Critical Care
Issue Number	4
Volume Number	17
Language	English
Publisher	BioMed Central
Publisher Date	2013-07-11
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Pulmonary Oedema Lung Weight Pulmonary Artery Occlusion Pressure Inspiratory Capacity High Peep
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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