• Chia-Fu Hsu, Jen-Suo Cheng, Wei-Chi Lin, Yen-Fen Ko, Kuo-Sheng Cheng, Sheng-Hsiang Lin, and Chang-Wen Chen.
• Medical Intensive Care Unit, Department of Internal Medicine, National Cheng Kung University Affiliated Hospital, Tainan, Taiwan.
• J Formos Med Assoc. 2016 Mar 1; 115 (3): 195-202.

Background/PurposeThe time required to reach oxygenation equilibrium after positive end-expiratory pressure (PEEP) adjustments in mechanically ventilated patients with acute respiratory distress syndrome (ARDS) is unclear. We used electrical impedance tomography to elucidate gas distribution and factors related to oxygenation status following PEEP in patients with ARDS.MethodsNineteen mechanically ventilated ARDS patients were placed on baseline PEEP (PEEPB) for 1 hour, PEEPB - 4 cmH2O PEEP (PEEPL) for 30 minutes, and PEEPB + 4 cmH2O PEEP (PEEPH) for 1 hour. Tidal volume and respiratory rate were similar. Impedance changes, respiratory parameters, and arterial blood gases were measured at baseline, 5 minutes, and 30 minutes after PEEPL, and 5 minutes, 15 minutes, 30 minutes, and 1 hour after PEEPH.ResultsPaO2/fraction of inspired oxygen (P/F ratio) decreased quickly from PEEPB to PEEPL, and stabilized 5 minutes after PEEPL. However the P/F ratio progressively increased from PEEPL to PEEPH, and a significantly higher P/F ratio and end-expiratory lung impedance were found at 60 minutes compared to 5 minutes after PEEPH. The end-expiratory lung impedance level significantly correlated with P/F ratio (p < 0.001). With increasing PEEP, dorsal ventilation significantly increased; however, regional ventilation did not change over time with PEEP level.ConclusionLate improvements in oxygenation following PEEP escalation are probably due to slow recruitment in ventilated ARDS patients. Electrical impedance tomography may be an appropriate tool to assess recruitment and oxygenation status in patients with changes in PEEP.Copyright © 2015. Published by Elsevier B.V.

21 keywords...

hide…