• Jean-Christophe Richard, Laurent Brochard, Lucie Breton, Jérôme Aboab, Philippe Vandelet, Fabienne Tamion, Salvatore M Maggiore, Alain Mercat, and Guy Bonmarchand.
• Medical Intensive Care Unit, University Hospital-Charles Nicolle, 1 rue de Germont, 76031 Rouen, France. jrichard@invivo.edu
• Intensive Care Med. 2002 Aug 1;28(8):1078-83.

ObjectiveReduction in tidal volume (Vt) associated with increase in respiratory rate to limit hypercapnia is now proposed in patients with acute lung injury (ALI). The aim of this study was to test whether a high respiratory rate induces significant intrinsic positive end-expiratory pressure (PEEPi) in these patients.DesignProspective crossover study.SettingA medical intensive care unit.Interventions And MeasurementsTen consecutive patients fulfilling criteria for severe ALI were ventilated with a 6 ml/kg Vt, a total PEEP level at 13+/-3 cmH(2)O and a plateau pressure kept at 23+/-4 cmH(2)O. The respiratory rate was randomly set below 20 breaths/min (17+/-3 breaths/min) and increased to 30 breaths/min (30+/-3 breaths/min) to compensate for hypercapnia. External PEEP was adjusted to keep the total PEEP and the plateau pressure constant. PEEPi was computed as the difference between total PEEP and external PEEP. The lung volume retained by PEEPi was then measured.ResultsIncrease in respiratory rate resulted in significantly higher PEEPi (1.3+/-0.4 versus 3.9+/-1.1 cmH(2)O, p<0.01) and trapped volume (70+/-43 versus 244+/-127 ml, p<0.01). External PEEP needed to be reduced from 11.9+/-3.4 to 9.7+/-2.9 cmH(2)O ( p<0.01). PaO(2) was not affected but the alveolar-arterial oxygen tension difference slightly worsened with the high respiratory rate (p<0.05).ConclusionsAn increase in respiratory rate used to avoid Vt reduction-induced hypercapnia may induce substantial gas trapping and PEEPi in patients with ALI.

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