• Z Bilen and I L Cohen.
• Division of Surgical Critical Care, Albany Medical College, NY 12208.
• Chest. 1993 May 1; 103 (5): 1489-94.

AbstractThe purpose of this study is to describe an unexpected degree of differences between expiratory occlusion plateau pressure (EPO) and airway opening pressure (Pawo) measured level of intrinsic positive end-expiratory pressure above externally applied (auto-PEEP) that was found in six critically ill patients. In six patients (ten studies), the presence and degree of auto-PEEP found during the EPO maneuvers was not confirmed by Pawo measurements. In five studies, flow tracings showed prolonged near zero flow toward end expiration and a slow rise to plateau during the EPO maneuver. Because of the static nature of the EPO determination, a rise in pressure could conceivably be caused by the presence of subcutaneous or mediastinal emphysema and retrograde flow across the airway defect during exhalation. We suggest another cause for auto-PEEP-dynamic hyperinflation from extrapulmonary flow limitation.

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